Inspection on 10/03/09 for Bywell House

This inspection was carried out on 10th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bywell House 26/05/09

Bywell House 07/05/09

Bywell House 05/03/08

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bywell House 2 Longfellow Road Worthing West Sussex BN11 4NU     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Webb     Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Bywell House 2 Longfellow Road Worthing West Sussex BN11 4NU 01903236062 01903236062 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Hazelwood Care Ltd care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 20. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home Bywell House is a care home registered to accommodate up to 20 older people in the categories dementia, (DE), and mental disorder (MD). The property is a detached building situated in a residential area on the outskirts of Worthing. The town centre and seafront are within walking distance and there are local shops and other facilities nearby. Buses and mainline trains are easily accessible. Care Homes for Older People Page 4 of 35 Over 65 0 0 20 20 Brief description of the care home People living at the home are accommodated in twenty single bedrooms, which are located on the ground and first floors. A vertical lift provides access to each floor. Communal accommodation consists of a lounge and a dining area, which are located on the ground floor. There is an enclosed garden to the front and side of the property for people to use. This service is privately owned by Hazelwood Care Ltd. The Responsible Individual who acts on behalf of the company is Mr. Manvinder Singh. The fees for this care home currently range from four hundred and eighty five pounds to five hundred and thirty five pounds per week. Care Homes for Older People Page 5 of 35 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 purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. During our visit to the home we talked to the manager and three care staff. We also case tracked three residents and looked at the care records of a further two residents, examined staff records, policies and procedures and other documentation. In addition to this we looked around the home and observed interactions between residents and staff. There is currently a safeguarding adults investigation being undertaken by West Sussex County Council. We considered information from this when visiting the home and looking at outcomes for residents. Evidence gained from our inspection supports the concerns identified that are currently being investigated by the County Council. Care Homes for Older People Page 6 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Residents must have clear individual care plans describing the support that staff give to meet identified needs. This must occur to ensure residents needs are met safely. The registered person must be able to demonstrate through the homes records that residents received where necessary, treatment, advice and other services from any required health care professional. This must occur to ensure residents health needs are met promptly and in full. All medication must be stored in line with manufacturers instructions.This must occur to ensure medication is safe to use. The registered person must ensure residents can have a bath as detailed in their individual care plans. This must occur to ensure residents health, welfare and dignity is maintained. Activities must be offered that are varied, flexible and meet the expectations, preferences and capacities of residents. This must happen to ensure residents have to opportunity to lead full and active lives. Residents must be offered a choice of meals that meet their individual assessed and recorded requirements. This must happen to ensure residents dietary needs and preferences are met. Staff must be respectfull of residents needs at meal times, offering support descreetly. Meal times must be unhurried, relaxed and enjoyable experiences. The registered person must ensure a risk assessment is completed and remedial action taken to make safe the window in in bedroom 1a. This must happen to reduce the risk of injury to the resident using this room. The registered person must ensure all residents bedrooms have working lights, hot running water and furniture in good working order. This must happen to ensure residents needs are met. The home must consult and act on any recommendations made by the Environmental Health Agency with regards to the kitchen. This must happen to ensure the kitchen is fit for the purpose of preparing meals for residents. Care Homes for Older People Page 8 of 35 The home must improve infection control measures including - eliminating odours, implementing sanitising policies and procedures for commodes and toilets, ensuring all areas of the home are clean and that staff use personal protective equipment when needed. This must happen to reduce infection control risks to residents. The registered person must ensure all required checks are completed prior to allowing staff to work with residents. If the registered person allows a person to commence work without obtaining a full enhanced CRB disclosure Department of Health guidance with regard to this practise must be followed in full. This must happen to reduce the risk of harm to residents. Sufficient numbers of suitably qualified staff must be on duty at all times. This must include being trained in moving and handling, first aid, food hygiene, infection control, safeguarding and dementia. This must happen in order that staff can support residents safely and understand their needs. Correct and safe moving and handling practises must be applied at all times. Also that moving and handling practises are reflected in residents individual risk assessments for moving and handling. This must happen to reduce the risk of injury to residents. Quality monitoring systems must be undertaken on a regular basis, including obtaining the views of people. This must happen to ensure residents receive a consistent and safe service. The registered person must ensure equipment designed for the safe transportation of residents is available in the home at all times. This must happen to reduce the risk of injury to residents. The registered person must be able to demonstrate through risk assessment that suitable numbers of qualified first aiders are on each shift as described in CSCI policy guidance:First Aiders. Medical advice must be sought whenever there is any change in a residents condition or if they complain of pain as a result of an accident. This must happen to reduce the risk of neglect to residents. The registered person must ensure suitable checks are carried out and recorded when bed rails are used by residents. This must happen to reduce the risk of harm to residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 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. Admission policies are in place that if followed should ensure prospective residents needs are identified before they move into the home. The specialist needs of residents with dementia are not being met resulting in poor care and quality of life. Evidence: As a result of a safeguarding investigation that is currently being undertaken at the home by West Sussex County Council a contract suspension by the local authority is in place. This means they are not placing or funding any new residents at the home. The service has also agreed not to admit any privately funded individuals. Therefore there were no new residents files that we could examine in order to assess if rigorous assessments processes have been undertaken by the home. We did however examine the homes admission policies and procedures. These give instructions that if put into practise should ensure prospective new residents needs are identified before they move into the home. Care Homes for Older People Page 11 of 35 Evidence: Arrangements are currently being made for two residents to move from the home and consideration being given to another. This is due to the current safeguarding investigation identifying that the individuals needs can no longer be met by the home. This was not recognised promptly by the home. A number of residents at the home have dementia. Evidence sited in other areas of this report indicates residents needs relating to dementia are not being met. This was particularly evident in areas including activities, meals and staff knowledge and practise. Bywell House does not offer intermediate care. Care Homes for Older People Page 12 of 35 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. A new care planning system is being introduced to the home but this is not being completed in full or accurately for all residents. This means that the personal and health care needs of residents are not being met consistently and safely. Not all medication practises offer safeguards to residents. Residents are not always treated with respect. Their rights to privacy are upheld. Evidence: We examined the care records for three residents. New care planning documentation is in the process of being implemented by the new manager, however we found work is still required to ensure plans are completed for all identified needs. Also some of those that are in place do not include specific instructions for staff detailing how identified needs should be met. In addition, we also found some plans, documents and individual risk assessments to contain conflicting information. This issue is one that has been identified by the social services safeguarding investigation and evidence from our investigation supports their findings. For example one residents care planning documentation includes a care plan for Care Homes for Older People Page 13 of 35 Evidence: personal hygiene that is not dated. This states they should receive chiropody every six weeks. Health records for this person evidence treatment by the chiropodist but not every six weeks. The same resident has a care plan for skin care (again not dated). This gives some information on actions needed by staff but no reference to diet or nutrition and how this can impact on skin care. It also states as a preventative measure to use the right equipment. The plan does not state what equipment is needed. The same person has a care plan for mobility (again not dated) that states they are independent and use a Zimmer Frame. This information contradicts the contents of their moving and handling plan. The second persons file we examined contains a care plan for sleeping that informs of the use of bed rails. In addition to this a risk assessment has been completed for use of this equipment. Neither document includes information about the use of rail covers to reduce risk or checks that must be undertaken by staff. We discussed this with the manager who confirmed staff do not carry out checks. We informed the manager to contact the Health and Safety Executive for information regarding the use of bed rails and checks that staff should undertake to reduce risk. The same persons file contained a blank Waterlow pressure risk assessment form, personal inventory and permission for use of bed rails. The file also contained a care plan dated 23.02.09 for food that states loves a milky tea with 2 spoons of sugar. At lunchtime we sat and ate with the residents (discussed in further detail in the lifestyle section of this report). We observed a member of staff give residents, including this person a cup of tea or coffee. All were given this with one spoon of sugar in. Individual daily records are completed for each resident. We found these to be detailed and informative, for example explaining what personal care, activities and daily routines residents have undertaken. Within the daily records for one resident we noted staff having recorded a number of instances when the residents behaviour due to dementia having impacted on the care they receive. Examples being, had difficult time, uncooperative despite given some encouragement and lots of reassurance difficult to change his clothes due to his not cooperative and very verbally aggressive and very uncooperative being put to bed last night. No care plan is in place for this resident with regard to dementia and how this may impact on the care they receive. All three of the residents files we examine contain bathing records. None have had a bath for three months, will all having records stating strip washes. For two of these residents their care plans state they would like to have a bath once a week. As a Care Homes for Older People Page 14 of 35 Evidence: result of the safeguarding investigation it has been identified that some of the bathrooms in the home have not been accessible due to lack of hoisting equipment. Evidence from this inspection supports the findings of the investigation. Health records for 2009 evidence residents have received treatment from a range of specialists including district nurses, general practitioners and chiropodists (although the chiropodist records do not evidence six weekly visits as indicated in some care plans). No evidence was supplied to us that demonstrates appointments are being made for residents to undertake dentistry or optical appointments. During our visit we witnessed two members of staff, carry out an unsafe moving and handling technique involving a resident. They were using a hoist and did not ensure space was available either side of the chair that they were attempting to lower the resident into. This resulted in both staff standing behind the hoist and neither being able to guide the resident in the sling into the chair. The resident almost fell out of the chair and became distressed. We alerted the manager of this situation immediately and she went and assisted the two staff members who were attempting to hoist the resident. The manager offered reassurance to the resident and he calmed down. One of the members of staff who was involved with moving and handling of the residents stated it was his own fault for rocking when spoken to and did not demonstrate knowledge of safe practise. We issued an immediate requirement during our inspection regarding this instructing that the registered person must ensure that correct and safe moving and handling practises must be applied at all times and that this may require a revision of the furniture layout in the lounge. We also instructed that moving and handling practises must be reflected in residents individual risk assessments for moving and handling. Also during our visit we observed residents being escorted around the home by staff using commodes (referred to as sani chairs in residents care plans) as a form of transport. These do not include footrests, resulting in residents limbs being at risk of injury. We asked the manager if she had information from the manufacturer that would demonstrate these could be used for the purpose of transporting residents. She said that she did not and informed us there is only one wheelchair available for residents to use in the home. We asked if risk assessments were in place for using this equipment and she stated no. We informed the manager that a requirement would be made and reflected in the inspection report but an urgent action letter would be issued before the report is published due to the need for urgent action in this area. When viewing accident records we saw on some occasions staff had recorded that residents complained of pain as a result of the accident. Records state that no medical Care Homes for Older People Page 15 of 35 Evidence: intervention was sought. we asked the manager to check if medical intervention was sought and recorded elsewhere. She did this and confirmed it had not. We were told that no- one living at Bywell House on the day of our visit was able to safely manage their own medication so we looked at the arrangements which the home has in place for making sure that people get their prescribed medication administered by staff. We looked at medication records, which included sampled of signatures for those staff having the responsibility of administering medication. Medication administration records were clear and completed in full. We noted that the room used to store medication was extremely warm on the day of our visit. A member of staff we spoke to confirmed the temperature in this room is not monitored. They agreed this should happen to ensure medication is stored within temperatures recommended by manufacturers. When examining medication and records we found evidence of one item (Isosorbide Monoitrate) being administered after its expiry date and another (liquid paracetomol) being stored in the medication cabinent when the dispensing label states it should be stored in a fridge. We drew these issues to the attention of the member of staff on duty responsible for administering medication. Systems for the management of controlled drugs are in place, including a controlled drugs cabinent and register. Stock that we sampled accurately reflected records in place. No care plan was seen to be in place for one resident who is prescribed a controlled drug (phyentonal) for the management of pain. Care Homes for Older People Page 16 of 35 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. Activities are offered but these are not varied and do not always meet the needs of all residents. There is little evidence that residents are helped to exercise choice and control over their lives. Dietary needs are catered for but choice is limited. Evidence: During the morning residents were observed sitting in the lounge watching television. During the afternoon an external entertainer came to the home to provide music. Residents were observed to enjoy this activity, with many singing and joining in. After this one resident was seen reading a newspaper and two others doing jigsaw puzzles. Two notice boards are located in the lounge and dining room. Staff that we spoke to told us these are used to advertise activities. One notice board gave information about the visiting music session taking place that day and the other about a planned activities that take place once a week for the month of March. When talking to staff about areas they thought the home could improve one stated activities. They explained that there are some puzzles and board games that residents can use but that these are limited. We asked what activities are offered for people with dementia and were informed none. Care Homes for Older People Page 17 of 35 Evidence: A lack of meaningful entertainment has been identified as an issue by the current safeguarding investigation. Evidence from our inspection supports this concern. At the beginning of our inspection we asked the manager to make arrangements for us to have lunch with the residents, including being given the same meal they would be having. At lunchtime we sat in the dining room with residents, joining two residents at their table. One was given a pureed meal, with all portions individually arranged on the plate. We observed the other resident having difficulty eating independently. Halfway through the meal a member of staff brought a plate guard and fitted it to the residents plate. This appeared to help. All residents were given meatballs, pureed potatoes and frozen mixed vegetables for lunch. We were informed by a member of staff they were cooking pasta for our lunch. We explained that we had requested the same meal as the residents and this was then provided. The meal was bland with little taste. No condiments were offered to residents and we observed half leave some of their food. No one was offered an alternative. Rice pudding was given to residents for dessert. Most residents appeared to enjoy this. Those that did not were offered a yogurt as an alternative. The meal that residents were given did not correspond with that advertised on the noticeboard or on the four week menu. The cook informed us this was due to the lunch time cook being on leave. The menu does not offer a choice of main meals. The manager informed us a new menu has been devised that will offer choices. She informed us this will be implemented shortly. During and after lunch residents were offered a choice of hot and cold drinks. As already mentioned earlier in this report we observed a member of staff put one sugar in all hot drinks (this contradicts information in some residents care plans). Patio doors are sited at the rear of the dining room. During lunch staff were seen about to let delivery men into the home via the patio doors. We told staff to inform the delivery men to use the front door of the home so their presence did not encroach on the privacy of residents eating, which they did. During the lunch time we also observed staff leaving and entering the home via the patio doors. Some residents were heard to complain about a draft when the doors were opened. Four staff assisted residents at lunch time. Three sat next to residents and offered assistance discreetly, one stood over residents when assisting to eat. Two of the staff assisting sat at the same table as one another. We did not hear them speak at all to the residents they were assisting. They were heard to have a private conversation and did not involve the residents in this. Some residents were heard to complain that the Care Homes for Older People Page 18 of 35 Evidence: meal was too hot. No staff were seen to respond to these complaints. A lack of clear choices around food and menus has been identified as an issue by the current safeguarding investigation. Evidence from our inspection supports this concern. Care Homes for Older People Page 19 of 35 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 process for residents, which promotes peoples rights to raise concerns. The home has not acted promptly to safeguard residents putting some at risk of neglect. Evidence: We saw that the complaints procedure is displayed in the home. The Manager informed us no complaints have been received at the home since our last inspection and the complaints log confirms this. There is a suggestions book on display at the entrance to the home. This contains no records. During our visit to the home we were told that the home has a copy of the revised West Sussex Multi Agency Safe guarding Adults procedures besides its own policies and procedures on safeguarding adults. Since our last key inspection there have been two safeguarding adults alerts made. One by a member of the District Nuring team and the other by a social worker. Concerns include residents not receiving health care intervention promptly, the home not recognising when it can no longer meet the needs of residents, lack of social stimulation and the provision of meals. These have been subject to investigation and whilst not fully concluded we are informed by West Sussex County Council residents have been subjected to institutional abuse and others to neglect. Evidence from this inspection supports concerns identified. Care Homes for Older People Page 20 of 35 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. Residents do not have a pleasant, clean and homely environment to live in. Evidence: We looked around the home and we were able to see areas such as the dining room, lounge, bedrooms, bathrooms, kitchen and laundry. Environmental issues have been raised as part of the current safeguarding investigation. These include the emergency call bell system that is in place not being accessible and appropriate for people with dementia, lack of heating in bedrooms, carpets being trip hazards, lack of hoisting and bathing facilities, damaged vanity units and odours in some bedrooms. Evidence from this inspection supports all concerns apart from the lack of heating in residents bedrooms. In addition we found areas of the home to have torn and damaged wall coverings, some bathrooms and toilets with broken and missing wall tiles, some residents bedrooms with no hot running water and some bedrooms without overhead lighting. The manager informed us that new beds and carpeting were on order for some bedrooms and we observed the homes handy person on site repairing bathrooms. When looking in one residents bedroom we observed that the window frame appeared damaged. When we touched it, the frame crumbled away from the glass pane. We Care Homes for Older People Page 21 of 35 Evidence: also observed what appeared to be fungi on part of the window frame. The residents bed is located next to this window. We raised concerns with the manager that adverse weather and/or the rotting window frame could result in the glass pane falling and injuring the resident. We issued an immediate requirement instructing that the registered person must ensure a risk assessment must be completed that demonstrates where possible the risk of injury to the resident is reduced. We also instructed that remedial action must be taken to make safe the window and arrangements be made for it to be repaired. Some bedrooms that we viewed contained commodes that were soiled with excrement. The manager confirmed no written procedures are in place for the sanitising of these but that domestic staff are employed. We also saw that a commode in use in one bedroom was made of wood. We discussed the potential infection control issues regarding this with the manager who agreed to have this removed and replaced. When looking around the home we saw toilet tissue with excrement on it on the floor outside of the first floor bathroom. We asked the manager to make arrangements for it to be removed to due to potential infection control hazard, which she did immediately. A member of staff removed this in our presence without using disposable gloves or apron. Blood was seen to be on a light switch in one residents bedroom. We asked that this be removed immediately, which it was. A number of other infection control issues were identified during our inspection. Due to our concerns we contacted the Health Protection Agency who agreed to visit the home to carry out an audit. We identified a number of areas of concern in the kitchen. These include food items inappropriately stored, staff entering the kitchen when food was being prepared, cooked and served after being in bathing/toilet facilities without washing their hands and kitchen equipment being soiled. Due to our concerns we contacted the Environmental Health Department who agreed to carry out a separate inspection. Care Homes for Older People Page 22 of 35 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. In the main staffing levels meet residents needs. Staff do not understand the needs of people with dementia and are not trained to care for residents. Recruitment practises place residents at risk. Evidence: The staffing structure at the home consists of the manager, care assistants, kitchen staff, housekeeping and maintenance. We spoke with three care staff on the day of our inspection and indirectly observed care practises. All indicated that they were aware of the needs of residents. However the amount of knowledge they demonstrated varied. For example when talking to one member of staff about exercises that people with dementia or of old age can participate in they laughed and expressed the view that because they have dementia they would not be able to participate. Also when we observed an inappropriate moving and handling technique (discussed in the management section of this report) the staff involved stated it had occurred due to the resident being difficult and uncooperative. We explained that this is not the case but that someone with dementia may not understand verbal instructions. Concerns have been raised as part of the current safeguarding investigation of institutionalised practises by staff. Findings from this inspection support this concern. Care Homes for Older People Page 23 of 35 Evidence: For example all residents were seen to be given on sugar with their tea or coffee at lunch time despite care plans indicating residents prefer half or two sugars. As already mentioned in this report no alternative meal was offered to residents who did not eat their lunch, staff were observed to ignore residents when assisting them to eat and all residents bathing records w viewed stated they had strip washes (when care plans indicate preferences for weekly baths). During the afternoon of our visit we heard a member of staff ask another if they would like a cup of coffee. The staff member replied, yes but i want to be able to taste it, do not want what we give them. By them we took this to mean the people who live at the home. We spoke to three of the four care staff on duty on the morning of our visit. When asked, they all confirmed they do not hold a National Vocational Qualification (NVQ). We spoke to the Manager about the care staff on duty, explaining that discussions with them and examination of records indicate none hold a NVQ qualification. We asked how she ensures suitable numbers of qualified staff are on duty each shift. The manager stated she has no system for monitoring this other than checking their individual training records. Also we asked the manager if a qualified first aider is allocated to each shift. She informed us that all staff apart from two new workers have completed the appointed persons course . Again the Manager stated she has no system for monitoring this and that a risk assessment has not been completed with regard to first aid and the needs of residents. We directed the Manager to the CSCI website where further information regarding this can be found. We looked at the staff files of three people working at the home (including the two newest people to commence work). Two contained the required documentation such as evidence of an enhanced CRB disclosure and two references and one did not. We discussed this with the manager who confirmed Department of Health guidelines with regard to staff working without receipt of a full enhanced CRB were not being followed. We have wrote separately to the responsible person regarding this situation. Training certificates on file for the same three members of staff evidence that two have received training for safeguarding, one moving and handling, one health and safety and one nutrition and diet. None contained evidence that they have received training in first aid, food hygiene, infection control or dementia. Care Homes for Older People Page 24 of 35 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. Management of this home is not meeting the needs of residents safely in terms of care planning, health care, choice, staffing and health and safety. Quality monitoring systems are ineffective and do not demonstrate that the home monitors the quality of service residents receive. Residents health, safety and welfare is not always promoted and protected. Evidence: The manager has been in post since January 2009. She informed us that she previously worked as a residential manager for a year but did not complete an application for registration. With regards to qualifications she informed us that she holds the Registered Managers Award and will be undertaking the NVQ level 4 in care. In addition to this she has undertaken courses in dementia, medication, first aid, food hygiene and safeguarding. At the time of our visit she had not submitted an application for registration. We informed the manager that this must be given priority. Reports in line with Regulation 26 of the Care Home Regulations 2001 were viewed. Care Homes for Older People Page 25 of 35 Evidence: These evidence that visits take place on a monthly basis and that discussions with residents and staff take place. The home has surveys that form part of its quality assurance system. These have not been distributed to residents, relatives and other representatives since 2007. The last annual audit of the quality assurance system has also not been undertaken since 2007. As already detailed in the health and personal care section of this report we witnessed an unsafe moving and handling technique involving a resident and residents being escorted around the home by staff using commodes (referred to as sani chairs in residents care plans) as a form of transport. We issued an immediate requirement during our inspection with regard to the moving and handling practice and have sent an urgent action letter with regard to forms of transportation. Bed rails are in place for a number of residents. The manager confirmed staff do not undertake checks of these items of equipment. Care Homes for Older People Page 26 of 35 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 27 of 35 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 19 13 In line with Regulation 13(4)(a)(c), 23(2)(b) the registered person must ensure a risk assessment is completed and remedial action taken to make safe the window in in bedroom 1a. This must happen to reduce the risk of injury to the resident using this room. 11/03/2009 2 38 13 In line with Regulation 11/03/2009 13(4)(5) the registered person must ensure that correct and safe moving and handling practises are applied at all times. Also that moving and handling practises are reflected in residents individual risk assessments for moving and handling. This must happen to reduce the risk of injury to residents. 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 In line with regulation 15 and Schedule 3(1)(b) residents must have clear individual care plans 22/05/2009 Care Homes for Older People Page 28 of 35 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 describing the support that staff give to meet identified needs. This must occur to ensure residents needs are met safely. 2 8 13 In line with regulation 13(1)(b) the registered person must be able to demonstrate through the homes records that residents received where necessary, treatment, advice and other services from any required health care professional. This must occur to ensure residents health needs are met promptly and in full. 3 9 13 In line with regulation 13(2) all medication must be stored in line with manufacturors instructions. This must occur to ensure medication is safe to use. 4 10 12 In line with Regulation 12(1)(a), (4)(a) the registered person must ensure residents can have a bath as detailed in their individual care plans. 22/05/2009 10/04/2009 22/05/2009 Care Homes for Older People Page 29 of 35 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 must occur to ensure residents health, welfare and dignity is maintained. 5 12 16 In line with Regulation 22/05/2009 16(2)(m)(n) the registered person must ensure activities are offered that are varied, flexible and meet the expectations, preferences and capacities of residents. This must happen to ensure residents have to opportunity to lead full and active lives. 6 15 12 In line with Regulation 12(1)(4)(a) the registered person must ensure residents are treated with respect and dignity at mealtimes and that these events are unhurried, relaxed and enjoyable experiences. This must happen to reduce the risk of neglect. 7 15 16 In line with Regulation 22/05/2009 16(2)(i) the registered person must ensure residents are offered a choice of meals that meet their individual assessed and recorded requirements. 22/05/2009 Care Homes for Older People Page 30 of 35 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 must happen to ensure residents dietary needs and preferences are met. 8 19 16 In line with Regulation 16(2)(c) the registered person must ensure all residents bedrooms have working lights, hot running water and furniture in good working order. This must happen to ensure residents needs are met. 9 26 13 In line with Regulation 13(1)(b)(4) the home must improve infection control measures including elliminating odours, implimenting sanitising policies and procedures for commodes and toilets, ensuring all areas of the home are clean and that staff use personal protective equipment when needed. This must happen to reduce infection control risks to residents. 10 26 16 In line with Regulation 16(2)(j) the home must consult and act on any recommendations made by the Environmental Health Agency with regards to the kitchen. 10/06/2009 22/05/2009 22/05/2009 Care Homes for Older People Page 31 of 35 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 must happen to ensure the kitchen is fit for the purpose of preparing meals for residents. 11 29 19 In line with Regulation 19 and Schedule 2 the registered person must ensure all required checks are completed prior to allowing staff to work with residents. If the registered person allows a person to commence work without obtaining a full enhanced CRB disclosure Department of Health guidance with regard to this practise must be followed in full. This must happen to reduce the risk of harm to residents. 12 30 18 In line with Regulation 18(c) 10/06/2009 the registered person must ensure sufficient numbers of suitably qualified staff are on duty at all times. This must include being trained in moving and handling, first aid, food hygiene, infection control, safeguarding and dementia. This must happen in order that staff can support residents safely. 10/04/2009 Care Homes for Older People Page 32 of 35 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 13 33 24 Quality monitoring systems must be undertaken on a regular basis, including obtaining the views of people. This must happen to ensure residents receive a consistent and safe service. 10/06/2009 14 38 13 In line with Regulation 13(4) 25/04/2009 the registered person must ensure detailed risk assessments are in place for the use of bed rails and that these include instructions on safety checks that must be carried out and recorded when used by residents. This must happen to reduce the risk of harm to residents. 15 38 13 In line with Regulation 13(1)(b) the registered person must ensure medical advice is sought whenever any change in a residents condition takes place, or if a resident complains of pain. This must happen to reduce the risk of neglect to residents. 22/05/2009 16 38 13 In line with Regulation 13(4) 10/05/2009 the registered person must be able to demonstrate through risk assessment Care Homes for Older People Page 33 of 35 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 that suitable numbers of qualified first aiders are on each shift as described in CSCI policy guidance:First Aiders. This must happen to reduce the risk to residents. 17 38 13 In line with Regulation 13(4)(b)(c) the registered person must ensure equipment designed for the safe transportation of residents is available in the home at all times. This must happen to reduce the risk of injury to residents. 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 31/03/2009 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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