Inspection on 26/01/09 for Carr Green Nursing Home

This inspection was carried out on 26th January 2009.

CSCI 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carr Green Nursing Home 20/07/09

Carr Green Nursing Home 01/02/08

Carr Green Nursing Home 13/09/07

Carr Green Nursing Home 08/03/07

Carr Green Nursing Home 15/05/06

Carr Green Nursing Home 06/10/05

Carr Green Nursing Home 07/04/05

Carr Green Nursing Home 17/11/04

Carr Green Nursing Home 19/04/04

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Hawkhills

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Carr Green Nursing Home Carr Green Lane Rastrick Brighouse West Yorkshire HD6 3LT     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: Lynda Jones     Date: 2 6 0 1 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 33 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 33 Information about the care home Name of care home: Address: Carr Green Nursing Home Carr Green Lane Rastrick Brighouse West Yorkshire HD6 3LT 01484710626 01484710626 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Flowertouch Limited Name of registered manager (if applicable) Mrs Sandra June Speight Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category terminally ill Additional conditions: Can provide accommodation and care for seven named services users - category DE(E) Date of last inspection Brief description of the care home Carr Green provides both personal and nursing care for 31 older people in what was once a school. The home is located in Rastrick, close to local amenities. There is a small, safe garden area at the side of the home and car parking is available in the grounds. All of the accommodation is on one level and there is level access to the building. There are single and double bedrooms available. None of the bedrooms have en-suite facilities. Bathrooms and toilets are near to the bedrooms. There is one large lounge Care Homes for Older People Page 4 of 33 0 0 0 Over 65 3 31 2 care home 31 Brief description of the care home and a dining room. The kitchen and laundry are in the basement. In addition to the weekly fee there is an extra charge for hairdressing, chiropody and personal newspapers. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The home was last inspected in February 2008 when it was assessed as being adequate. Care Homes for Older People Page 6 of 33 This inspection was carried out to assess the quality of care provided to people living at the home. The inspection process included looking at the information we have received about the home since the last key inspection as well a six hour visit to the home. During the visit we spoke to people who live in the home and to the staff on duty. We observed care staff delivering care, looked at various records and looked around the home. We sent surveys to people who live and work at the home and to health care providers who visit. Information received in this way is shared with the home without identifying who has provided it. We received 5 completed surveys and we have used comments from them in this report. 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 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 8 of 33 Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home needs to be available so that people can take it away with them after making a visit or enquiry. Evidence: There is a statement of purpose and service user guide in the entrance area but there are no copies for people to take away to read. The photocopier has not been working for some time and staff do not have any working printing facilities. They told us they usually tell people about the home when they show them round. Since the inspection the provider has sent us a copy about the brochure of the home. The manager said that most people are referred to them via the local authority and copies of their care needs assessments are always requested before any agreements are made about coming to live at the home, the manager also visits people to carry Care Homes for Older People Page 11 of 33 Evidence: out her own assessments. These are important because they should indicate whether the home is suitable and can meet each persons needs. The homes assessments we looked at did not include any detailed information about peoples needs and did not include any information about the support they require. On the care plans we looked at the assessment information that is intended to be gathered soon after admission, had not been fully completed. The way in which some of the documents have been filled in suggests that some staff do not understand the purpose of gathering this information. We provided the manager with examples of this. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are not being met. Evidence: We looked at four care plans because we wanted to see what individual needs had been identified and what action staff have to take to meet these needs. The plans we looked at lacked detail, they had not been reviewed regularly and they did not contain up to date information about the care and support that people require. This means that people may not be receiving the care that they need. Some of the staff that we talked to had a good understanding of peoples needs and of their preferred daily routines but we could not always find this information in the records. This important information is often passed on verbally amongst the team of care staff which means it would not be possible to meet peoples needs with any consistency based on what is recorded in the care plans. These are some of the points we fed back to the manager at the end of the inspection: Care Homes for Older People Page 13 of 33 Evidence: Many of the assessments that preface the care plans are generic. They are pre printed, requiring staff to answer yes or no or indicate the most relevant word that best describes each persons abilities, from two or three options. For example, Vision -good, poor, blind. Hearing - good, poor, deaf. Attitude -anxious, withdrawn, distressed, cheerful. Mobility- fully mobile Yes/No. These assessments do not give a detailed picture of peoples abilities and of the sort of help and support people need. Some of the plans are not about individualised needs but about the sort of day to day care that anyone living in a home has a right to expect. For example the outcomes for one person were to feel comfortable; to have their nutritional and hydration needs met; for dentures to be clean, to fit and be comfortable; to be continent and pressure sore free; to feel happy, reassured and free from falls. We looked at an assessment completed by a social worker that told us about significant mental health problems that had been experienced in the past by one individual. The information from the social worker had been completed two months before this person moved into the home but this was not referred to at all in the care plan. The section of the plan relating to mental health needs told us only that this person was quiet and forgetful and the goal in the plan was for this individual to feel happy and secure. There is no evidence that this persons needs have been fully evaluated, which means that they may not be being met. One eating and drinking plan, written eight months ago, noted that the person has loose dentures which is a problem and stated that a dental appointment should be made. We could not find any information to show that this had been followed up. On the day we visited this person was not wearing dentures. In the chiropody section of a care plan we noted that one person is diabetic. There was no care plan regarding diabetes. We could not tell how the diabetes is controlled nor how frequently blood sugar levels need to be monitored. We know from the records that this person has had very high and very low blood sugar levels and has needed medical treatment for this. We could also see from the records that this persons blood sugar levels are frequently recorded as being outside the normal range. This means that this individual may not be receiving the medical care they need. The plans we looked at told us that people were incontinent of urine. We could find no individual plans about continence management and there was no information about the type of pads in use. One plan indicated that a person needed a continence assessment to determine which sort of pad needed to be used. Nothing had been recorded to indicate that the assessment had been carried out. Care Homes for Older People Page 14 of 33 Evidence: We read a note on one plan reminding staff to ask family members if their relative usually wore glasses. An earlier assessment carried out at hospital, just prior to admission, indicated that this individual does wear glasses. This suggests that people are not always looking at all of the information provided when people move into the home. The plan for one person with dementia is to ensure that pain relieving medication is given when needed. There is no information telling staff about any behavioural signs they should look for to ascertain whether this person is experiencing pain. This means that this person may not be receiving their medication when it is required. The pressure sore management plan for one person told us that a profiling bed with a Spenco mattress was being used, but the notes made by the visiting tissue viability nurse stated that a Nimbus 3 mattress was required. When we checked, the corect mattress was in use but the care plan had not been updated to reflect the change in this persons needs. Accident records relating to one person indicate that they have fragile skin and have sustained skin tears during the delivery of their care. There was no risk assessment or care plan indicating what preventative action staff should take to try to avoid further skin tears. We could find no evidence to indicate that people are consulted about the care they receive. Some people living at the home are able to say if the care and support they receive suits them or if it can be improved in any way. Other people suffering from dementia may not be able to comment, but some have relatives who visit regularly who may wish to be involved. There are no specimen signatures of staff with the records which means that it is not easy to identify who has administered medication. We could not tell for example whether R in the records denoted refused medication or if it was the initial of a member of staff. According to the records people are not always receiving their medication as prescribed this means they may not be receiving the health care that they need. We found several gaps on the MAR (medication administration records) sheets which we discussed with the manager at the end of our visit. For example, according to the records for one person we found that Ensure is prescribed daily, the record sheet that we looked at started on 5/1/09 but there were no enties to show it had been given. When we asked the manager she thought it was being given at night, if that is the case it is not being recorded. There were no entries on the MAR sheet for 5/1/09 to show that this person had received any of his prescribed medication. Paracetomol syrup is prescribed for pain but as there were no Care Homes for Older People Page 15 of 33 Evidence: entries on the records we could not tell if it had been offered and refused or not offered at all. According to the records Zopiclone was precribed to be given at night but the home had run out of stock on 16/1/09. This medication is given to help the person sleep. The records for another person indicate that eye drops are to be administered four times daily. The records show that they are being administered twice daily, there is no explanation for this change. One person had been discharged from hospital the previous day with their prescribed medication that was to be given in a morning. The medication had been given by staff at the home the previous evening contrary to instruction. This means that this person may have been given the same medication twice in one day, once at hospital and again in the evening. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some activities on offer to keep people stimulated. Meals at the home are good offering choice and variety. Evidence: On the plans we looked at we could not find much information about the sort of life experiences people have had and the sort of daily routine that they prefer. This information is useful because it helps staff understand something about peoples backgrounds, families, work experiences etc. It also helps staff to make conversation with people and to make sure they continue to live their day to day life as they want to. Most of the information on the plans starts with the circumstances leading up to the move into the home. There is a pleasant atmosphere in the home. Staff are pleasant and visitors are made to feel welcome. Most of the staff know people quite well; they know how they prefer to spend their time and they have an understanding of peoples preferred routines. They pass this information on to each other verbally, it is not in the plans. There appears to be a big difference in the skills of staff in the way they communicate Care Homes for Older People Page 17 of 33 Evidence: and engage with people who live there. We saw some good humoured banter from staff who know people well and also witnessed some interactions that indicated to us that some staff know very little about people. For example, one person who moved into the home recently asked why she was there and a member of staff shouted across the room to another member of the team to find out. This same member of staff proceeded to add to this persons confusion by telling them they had moved to Carr Green from a different area of the country (which they had) but staff got the area wrong. Some staff communicate poorly with people who may be hard of hearing. We observed staff looking in the opposite direction when speaking to people, who then misunderstood what was said to them. This needs to be adressed by the manager. During the morning we sat in the lounge where we saw six people sitting with the TV on, with a member of staff present. No one watched the TV except the member of staff who also rarely talked to any of the people in the room. For two hours most people were asleep, waking only when drinks were served mid morning. At one point another member of staff took over in the lounge, this person sat separately from everyone else writing daily reports. People woke up again when it was time to move from the lounge to the dining room for lunch. Two other members of staff on duty were extremely busy caring for those people who spend most of their time in their rooms or need to be cared for in bed. In the afternoon the activities organiser was present and thirteen people took part in a floor game of snakes and ladders which they appeared to enjoy. The activities organiser is present for 3.15 hours each weekday. People told us they enjoy all the meals at the home. We talked to the catering staff, they are interested in hearing what people think about the menus and will incorporate dishes that people ask for. They are very keen to ensure that they can provide wholesome, nutritous food for everyone. Although the menus are planned in advance we were told that the catering staff had experienced recent difficulties in keeping to them because the owners of the home amended the food order without reference to the catering staff. When we were there two large bags of frozen mince and frozen diced chicken were delivered. The cook said she had ordered fresh meat but the order had been changed. A gammon joint was taken off the order and the home has been told they can now only have one joint of meat each week. Staff told us that they had been told tuna fish is too expensive to place on order. The kitchen is poorly equipped in terms of cooking dishes and pans, it is remarkable that the catering staff turn out such good food and they are not injured. Most of the Care Homes for Older People Page 18 of 33 Evidence: pans do not have handles on. We saw two very large pans on the cooker without handles that had to be moved off the boil with a cloth, placing the catering staff at risk of scalding themselves. There is only one casserole dish in the entire home, which is cracked and the cook said she would not use it. People living there have to eat some of their meals out of plastic bowls because there are not enough pots to go round. Staff told us they have requested more bowls, cups and spoons but they have not been supplied. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is not clear whether staff have received adult protection training, this means that they may not be aware of abuse in its different forms and what they need to do to make sure people in their care are safe. Evidence: There is a complaints procedure on display in the home and it is outlined in the statement of purpose and serice user guide. When we looked at the complaints log no complaints had been recorded about the service. The log contained details of a complaint from the home about their disatisfaction with a training company they had used. As this is not about the service provided at the home it would be better recorded elsewhere. Records of complaints are not recorded properly. The manager told us she had recently received a verbal complaint from a relative about clothes being returned from the laundry unironed. She said she had recorded details of the complaint and action taken but we were unable to locate this information. It is important that concerns and complaints are properly recorded so that any common themes or trends can be spotted. In the last report we said that all of the staff must have adult protection training by November 2008 but when we visited we were unable to establish whether staff have Care Homes for Older People Page 20 of 33 Evidence: received this training because the training records are not up to date. After the last inspection the provider sent us copies of certificates showing us that twelve members of staff attended a half days training course on Safeguarding Vulnerable Adults held in July 2008. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable environment but work needs to continue on improving the decor, lighting and furnishings to improve the overall standard. Evidence: The home is clean and odour free. The bedrooms are quite large. Many were double rooms that are now being used as singles. We saw that many people had brought in their own furniture, ornaments and pictures to personalise their bedrooms and make them theirs. The carpets in some of the corridors need to be replaced or repaired. In some parts of the corridors the carpets are coming apart and have been joined together by tape, in other areas the carpet is frayed and worn, presenting a trip hazard. The lounge is spacious and comfortably furnished. The dining room is dull because the lighting is not suitable for the size of the room. There is no plan for redecoration or refurbishment. Some decorating has taken place over the past year but there is no strategic plan to upgrade the home that the manager is aware of. Care Homes for Older People Page 22 of 33 Evidence: Infection control measures are poor and this places people at risk of cross infection. The mechanical sluice disinfector is out of order and has been for a long time. A requirement was made in the last report for this to be repaired. We were told that staff rinse and spray disinfected commode pots and urinals after use. Following an outbreak of infection in December 2008 the Health Protection Agency advised the home owner that a sluicing facility and washer disinfector are essential to ensure effective decontamination of commode pans. The manager said she does not know if it will ever be repaired. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels have been reduced without any regard for the needs of people living at the home. This means there is no guarantee that peoples needs will be met. Evidence: According to the duty rota there is a qualified nurse on duty all day and all night. In the mornings and afternoon there are also four care staff and three care staff are on duty in the evenings. Staff told us that the level of cover has very recently dropped to this level on the instruction of the owner. There used to be five care staff during the day, reducing to four in the evening. The manager said she has not been consulted about the reduction in staff cover and as there has been no change in the needs of people living at the home and no change in occupancy levels, the manager said she does not know why the staffing level has been changed. After the inspection, the provider told us he had discussed this issue with the manager. Many people living at the home are being nursed in bed, many people need care and support from two members of staff. According to the information provided before the inspection, 9 people are bedfast, 14 people require help with dressing and undressing, 18 people need help to wash and bathe, 15 people have continence problems and need Care Homes for Older People Page 24 of 33 Evidence: support to go to the toilet. While we were at the home two members of the team were extremely busy making sure that people in their rooms received the care that they required. Staff were also stretched at meal times as they tried to ensure that people received the assistance they needed to eat and drink. The manager must keep staffing levels under review to ensure that peoples needs can be met at all times. The needs of people who want to move into the home must be assessed very carefully; people with high levels of dependency should not be accommodated unless there is scope to increase staffing levels. We checked a sample of staff records relating to people who have been recruited recently. References are taken up and checks carried out before people start work at the home. This is done to make sure prospective staff are suitable and to ensure that the people living there are safe. There is no evidence that new staff have completed induction training equivalent to the Skills for Care common induction standards. On one file we looked at we could see that the homes own induction booklet had been partially completed. 18 areas had been signed off as having been covered in one session alone, we could not find any details about the information covered. Training records are not up to date. We could not find any records in the staff files we looked at and the manager said she did not have an up to date training matrix, this means that it is not possible to get a picture of what training staff have had and what training they need. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not run in the best interest of the people living there. Evidence: The registered manager is an experienced nurse who has worked with older people for a number of years. She is planning to leave the post soon and has given three months notice to the owner. We do not have any details of plans to recruit a new manager. It is important that the person appointed is a competent, skilled manager because we have identified a number of shortfalls in the service that must be addressed. The manager works full time hours over three days a week. She said the majority of her hours are worked on shift as the nurse in charge. She has only a limited amount of supernumerary time. The supernumerary time she is allowed does not give her enough time to deal with all the management and administrative work she has to do as registered manager, such as staff supervision and appraisals and training records, which are not up to date. After the inspection the provider wrote to us to say that Care Homes for Older People Page 26 of 33 Evidence: more than a third of the managers contracted hours are supernumerary. He said this is more than sufficient to carry out the administration work for a home with just twenty residents. The company that owns the home does not provide sufficient support to the management team. The registered manager has no control in certain areas, particularly where funding is involved. Evidence indicates that the home is not well resourced, there is no plan for the future development of the home. There is no budget or plan for refurbishment and there is no evidence of any strategic planning. We have included examples in this report regarding the company cutting staffing levels, not supplying food items and utensils that have been requested and failing to repair equipment. We could find no evidence of formal consultation with people who live at the home or their relatives about the quality of the service provided and we could not see any evidence of people being asked about their own care. The manager said she has not had time to send quality assurance surveys to people who use the service and their relatives. Residents and relatives meetings are held. In 2008 three meetings took place. The owner of the home visits most weeks, he is required to complete a monthly report on the conduct of the home. This is not being done on a regular basis. The last report was completed in December 2008 and the one before that was completed in September 2008. Both reports highlighted maintenance/decoration work that needs to carried out but this has not been started. After the inspection, the provider sent us copies of reports for October & November 2008 annd January 2009. We checked the records of money held on behalf of people who live there. The balance of money could be reconciled with the totals on the finance records, although we did point out some minor arithmetical errors. Care Homes for Older People Page 27 of 33 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 9 13 (2) The manager must make sure that steps are taken so that medications are dealt with safely. People must be given their medications as prescribed by their doctors so that their health and general wellbeing is maintained. 30/03/2008 2 18 13(6) All staff must have adult 30/04/2008 protection training so that they all know how to recognise abuse and what action they need to take if it is suspected. This will help to make sure people living in the home are not at risk. Timescale of 22/11/07 given at the last inspection in September 2007 has not been met. 3 19 23 The provider must take steps 30/04/2008 to: Replace or repair the damaged/worn carpets in the corridors. Repair the mechanical sluice disinfector. The provider must make sure 30/04/2008 that staff receive appropriate Page 28 of 33 4 30 18(1)(c) Care Homes for Older People training that helps them to maintain the health, safety and well being of people living in the home and themselves. This must include training about the specialist needs of people such as dementia and learning disabilities. The provider must make sure that new staff receive induction training that is to Skills for Care common induction standards. The provider must make sure that people who provide training are qualified and competent to do so. All staff should have personal training and development plans that are reviewed at regular intervals. Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 When people are assessed 17/03/2009 before they move into the home all of their nursing and personal care needs must be taken into consideration before they are offered a place. This will make sure that the home can meet all of their needs. 2 7 15 People and/or their 17/03/2009 representatives must be involved in the care planning process. This will make sure people are consulted about their care and support. 3 7 15 Care plans must be in place that address peoples ongoing health care needs. This will make sure they receive the treatment and care they need. 17/03/2009 Care Homes for Older People Page 30 of 33 4 9 13 Medication must be given as 17/03/2009 prescribed and a record must be made at the time that it is given. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. 5 16 17 A record must be kept of all complaints made together with details of investigation and any action taken. This will help to highlight any common themes and improve the service. 17/03/2009 6 27 18 The staffing levels in the home must be kept under review. There must be enough staff on duty to make sure that peoples needs are met consistently. This will make sure people get the care that they need. 17/03/2009 7 33 26 Arrangements must be 31/03/2009 made to carry out monthly visits to the home and make monthly reports available about the conduct of the home To ensure that the home is being run in the best interests of people living there. 8 36 18 Arrangements must be made to provide staff with supervision. 17/03/2009 Care Homes for Older People Page 31 of 33 To ensure that their practice is kept under review and their training needs are identified. 9 38 16 Sufficient kitchen equipment 17/03/2009 must be provided such as pans, crockery and other utensils that are suitable and safe to use. To reduce the risk of accidents and make sure that sufficient equipment is available for use. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 1 12 Information about the home should be available to give to people when they look round the home. Care plans should include information about peoples preferred routines, hobbies and interests and their likes and dislikes. Care Homes for Older People Page 32 of 33 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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