Inspection on 19/11/09 for Castle Court Nursing Home

This inspection was carried out on 19th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Castle Court Nursing Home 25/08/10

Castle Court Nursing Home 16/06/10

Castle Court Nursing Home 10/12/07

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Castle Court Nursing Home Margrove Road Boosbeck Saltburn-by-Sea TS12 3BL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Katherine Acheson     Date: 1 9 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Castle Court Nursing Home Margrove Road Boosbeck Saltburn-by-Sea TS12 3BL 01287653990 01287651600 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Continuum Healthcare Limited care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 38 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP, maximum number of places 19 Demendia, Code DE - maximum number of places, 19 Date of last inspection Brief description of the care home Castle Court Nursing Home is registered to provide personal and nursing care to a maximum number of thirty eight people. The home provides care to both older people and older people with dementia. Castle Court is situated in Boosbeck on the outskirts of Guisborough and Skelton. A bus service is available to transport people locally. The building was formally an old school that has been converted into care home. Care Homes for Older People Page 4 of 35 Over 65 0 19 19 0 Brief description of the care home The home is divided into two units. The ground floor of the home accommodates twenty eight older people. There is a large lounge, small lounge and dining room. There are twenty eight single bedrooms some of which have ensuite facilities consisting of a toilet and hand wash basin. The first floor of the home accommodates ten older people with dementia. Communal space consists of a combined lounge/dining room. The amount of communal space on this unit is being looked at to determine if there is sufficient space for people. There are ten single bedrooms one of which has ensuite facilities. There is a passenger lift. There are panoramic views of the Cleveland hills and surrounding countryside. The cost of care at the time of the inspection ranged from £437.75 to £598.90 a 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: one star adequate 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 one star. This means that people who use the service experience adequate quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some regulations from previous inspections reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. This unannounced key inspection took place on 19th November 2009. Two Inspectors and an Area Manager from the Care Quality Commission did the site visit. The inspection took place sooner than originally planned because the Care Quality Commission received an anonymous expression of concern about the welfare of people Care Homes for Older People Page 6 of 35 with dementia whilst redecoration was taking place on the dementia unit. Before this inspection visit we looked at all of the information that we have received since the last inspection of the service on 10th December 2007. The manager completed and returned an Annual Quality Assurance Assessment, (AQAA). The AQAA is the services self assessment of how they think they are meeting national minimum standards. This information was received before the inspection and was used as part of the inspection process. The reason for the inspection was to see how good a job the home does in meeting the national minimum standards set by the Government for care homes. Numerous records were examined including care records of people living at the home, medication records, risk assessments, complaints and staff records. People living in the home, a relative and staff working there were also spoken to. Discussion also took place with the manager and deputy manager. After the inspection discussions took place with the home owner. Before the inspection surveys for people that use the service and surveys for staff were sent out to the home for the manager to distribute. Surveys sent to people that use the service were asked to comment on care received. Surveys sent to staff were asked to comment on what it was like working at the home and training received. We received fifteen surveys from people that use the service. We received five surveys from staff. Comments in surveys received can be read in the main body of the report. Following this inspection a discussion took place with Redcar & Cleveland Borough Council contracts and commissioning department to inform them of our findings. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Since last inspection a number of improvements have been made to the home environment. The large ground floor lounge has been plastered, painted and new curtains have been fitted. The downstairs dining room has also been re-decorated and new dining room furniture has been purchased. Changes to the environment have meant that all bedrooms in the home environment are for single occupancy. The majority of first floor corridor areas at the home have been plastered and painted to enhance the environment of the dementia unit. The last phase of the plastering and painting was ongoing at the time of the visit. Some staff working at the home have now achieved an NVQ level 3 in Care with others working towards achieving the qualification. Since the last inspection of the service an administrator has been employed to assist/support the manager with the day to day running of the home. Care Homes for Older People Page 8 of 35 What they could do better: Some improvement is needed in respect of record keeping. A Medication Administration Record (MAR) is a chart that details prescribed medication and is signed by staff to say medication has been given. Handwritten MAR charts should be countersigned by a second person to confirm that they have been written up correctly. The majority of hand written MAR charts had not been countersigned. At the bottom of the MAR chart there is a list of codes that are to be used if medication is not given. Codes were not being used correctly. A number of MAR charts detailed prescribed creams but were not signed for as applied. The manager said that this was because those people were responsible for applying their own creams. MAR charts should be updated to advise if a person is self administering their medication. Medication administration and recording practices are not robust enough to ensure that people will always receive their medicines accurately as prescribed. An audit of medication for one person identified some concern. On the day of the inspection visit the home were on day nine of a twenty eight day supply of medication. A count of one medication for a person indicated that there were still the same number of tablets in the box that had been supplied to the home at the beginning of the month. This medication had not been signed for as given. The Manager advised that she thought that medication had been given and that staff had used stock that had been carried over from the previous month. Records were not kept of medication carried over from the previous month. Medication carried over from the previous month should be documented to on the MAR to enable auditing. A record of medication competency assessments should be kept to enable staff to review their practice and provide confirmation that assessments have taken place. Care plans need to be developed further to ensure that they are individual to the person. This will help to promote independence, ensure that care needs are met and that care is delivered in such a way that is acceptable to the person. Care Plans need to be reviewed and evaluated on a monthly basis or more often as needed. Risk assessments for people who have bed rails should be signed by a multidisciplinary team including the person who uses the service to confirm that they are the best and safest option to maintain safety. The complaint procedure needs to be updated to include names and contact details of who to complain to. The adult protection procedure needs to be updated to link to No Secrets, Teeswide inter-agency policy, procedures and practice guidance (The purpose of this policy is to assist staff of all agencies in working together to identify and support adults who may be vulnerable to abuse). This procedure should also be updated to reflect the change of regulator to the Care Quality Commission The current security and safety arrangements at the home should be reviewed. Consideration should be given to fitting an appropriate locking system to the front door of the home to ensure the safety of people. Environmental changes to the first floor of the home has meant a reduction in communal space for people with dementia. The registered person must ensure that there is sufficient communal space for people, particularly those who have dementia. The registered person needs to advise the Care Quality Commission in writing of the Care Homes for Older People Page 9 of 35 amount of communal space in square metres for each person on the older persons unit and the amount of communal space in square metres for each person on the dementia unit. The bathroom near to room 27 and bedroom 31 need redecorating following the damage caused by a leak. Both sluices on the ground and first floor of the home would benefit from refurbishment. The plaster and paint in the first floor sluice was peeling off. The ground floor sluice sink contained cupboards that were bare wood and as such could not be cleaned properly. The home does not have a sluice machine to disinfect commode pots and urinals. The registered person needs to ensure that appropriate sluicing facilities are provided. The cracked sluicing sink in the laundry should be replaced. This will help to prevent the spread of infection. The inspection took place sooner than originally planned because the Care Quality Commission received an anonymous expression of concern about the welfare of people with dementia whilst redecoration of the dementia unit was taking place. The inspection highlighted that the programme of re-decoration had not been well managed. People with dementia were sharing a small lounge on the ground floor of the home. There was insufficient room for people to move around, insufficient small tables and there wasnt any seating for visitors. The inspection also identified that workmen were staying at the home and sleeping in the empty bedrooms until the refurbishment was complete. The home owner advised that the workmen were employees of the the company and as such had been through a thorough recruitment procedure. We have advised the home owner that this is inappropriate, however if they choose to continue with such arrangements now or in the future they must identify any risks to people that use the service and inform the Care Quality Commission in writing how they are to safeguard people. It was observed that the front door of the home is left unlocked throughout the day. Numerous people were able to enter and leave the home without the staff knowing. The security and safety of people that use the service should be considered particularly those people with dementia. The registered person needs to ensure that the home redecoration programme is well managed. Unnecessary risks to health or safety must be eliminated to ensure the health, safety and wellbeing of people that use the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 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 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments of people who are to use the service take place before they move into the home to ensure all needs can be met. Evidence: Before going into Castle Court people who are to use the service are assessed by a social worker or health care professional. This assessment is forwarded to the home for the manager or deputy manager to look at to determine if the needs of the person can be met. Once this assessment has been reviewed the manager said that she visits the person at home or in hospital to introduce herself, answer any questions about the home and to carry out a further assessment of the person. If a person is funding their own care an assessment is usually only undertaken by the manager of the home. Following assessment the manager said that she sends a questionnaire to the persons Care Homes for Older People Page 12 of 35 Evidence: GP to find out a medical history. A questionnaire is also sent to family to find out a life history. During the inspection four files of people that use the service were selected at random. Files looked at did contain evidence of assessment. People who are to use the service and their relatives are welcome to visit the home, have a look round and meet the staff. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general people who use the service are happy with the care that they receive, Care plans are insufficiently detailed and some assessments are incomplete. Medication administration and recording practice are not robust enough to ensure that people will always receive their medicines accurately as prescribed. Evidence: The files of four people that use the service were looked at during the visit, two from the dementia unit and two from the older persons unit. Files contained a good assessment of needs for each person. An example of this was one persons assessment highlighted that to help them to be independent with eating they needed their food to be cut up. Another assessment in respect of bathing identified that the person could wash their body, clean their own teeth but needed help with applying creams and lotions. Files looked at during the visit contained numerous other assessments including nutritional, moving and handling, and continence. Some of the assessments were Care Homes for Older People Page 14 of 35 Evidence: incomplete or had not been updated on a regular basis. One file looked at during the visit contained a BASOLL assessment (the behaviour assessment of later life). The purpose of the assessment is to determine a complete picture of a persons level of functioning and to give guidance in the care planning. This assessment had not been completed for the person. Two files looked at during the inspection contained a detailed history of the person including childhood, family, working years and interests. This is particularly useful when caring for a person with dementia. Following assessment plans of care are developed. Care plans are records that are used by care services to show what sort of help each person needs and how staff will provide that care. Care plans looked at during the visit were not individual to the person and would benefit from more detail. One plan of care highlighted that a person had been diagnosed with diabetes. The care plan stated, Follow healthy diet but didnt include likes and dislikes. The care plan didnt identify if the person was self caring or if they were able to manage/control their diabetes. The plan of care advised that the persons blood sugar needed to be checked twice a day. Records examined during the visit identified that the blood sugar was not being checked as often as this. One person was identified as needing a catheter, however the file of this person did not contain a care plan. This person did have a record which stated the correct catheter to use and contained some entries of when the catheter had been changed, however this had not been updated for some time. Two of the four care files looked at during the visit contained evidence to confirm that care plans had been reviewed and updated on a monthly basis but two did not. There is clear evidence of the involvement of GPs, district nurses and other healthcare professionals such as chiropodists. People living at the home confirmed that if they were feeling unwell, the GP would be called. During the inspection visit the manager and staff were observed to interact well with people that use the service and visitors. Staff approached people in a supportive and respectful way. Risk assessments were evidenced on some files looked at. One risk assessment detailed how a person needed bed rails to ensure their safety. This risk assessment contained good detail, however needed to be signed to confirm that the use of bed rails had been discussed with a multidisciplinary team including the person who uses the service to confirm that they were the best and safest option to maintain safety. Care Homes for Older People Page 15 of 35 Evidence: People spoken to during the visit and surveys received were in general complimentary about life in the home and care received. Comments made included, I feel that the home provides good care. If you need help it is always available I enjoy my stay here. I get on well with all the staff. They are always helpful I have lived her for a year and have always been happy I think theyre very good, very helpful Everybodys so kind Two people spoken to during the visit did express some dissatisfaction and said that they had spoken to the home owner who was taking action to address their concerns. Both people said that they did not wish to pursue this with the Care Quality Commission. During the inspection arrangements for receiving, storing, administering, recording and disposing of medication were observed and examined. The manager advised that both nurses and care staff are responsible for giving out medication. She said that those responsible for administering medication have received appropriate training, receive regular medication update training and have their competency checked. Records of medication competency checks were not available for inspection. Some improvement is needed in respect of record keeping. A Medication Administration Record (MAR) is a chart that details prescribed medication and is signed by staff to say medication has been given. Handwritten MAR charts should be countersigned by a second person to confirm that they have been written up correctly. The majority of hand written MAR charts looked at during the visit had not been countersigned. At the bottom of the MAR chart there is a list of codes that are to be used if medication is not given. Codes were not being used correctly. A number of MAR charts that detailed prescribed creams were not signed for as applied. The manager said that this was because those people were responsible for applying their own creams. An audit of medication for one person identified some concern. On the day of the inspection visit the home were on day nine of a twenty eight day supply of medication. A count of one medication for a person indicated that there were still the same Care Homes for Older People Page 16 of 35 Evidence: number of tablets in the box that had been supplied to the home at the beginning of the month. This medication had not been signed for as given. The Manager advised that she thought that medication had been given and that staff had used stock that had been carried over from the previous month. Records were not kept of medication carried over from the previous month. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service lead fulfilling lifestyles through exercising choice and control over how they spend their day. Food provided is enjoyed, which helps to maintain wellbeing. Evidence: The Manager said that the home employs an activity co-ordinator to plan, arrange and take part in activities for people that use the service. The activity co-ordinator works twenty hours a week, Monday to Friday. She said that activities take place from 10:am until midday and from 1:30pm until 3:30pm. Activities include bingo, quizzes, dominoes, reminiscence and listening to music. The activity co-ordinator spends some time with people on a one to one basisas well as group activities. Trips out this year have included Whitby in April and Redcar in July. Two people who use the service regularly use Dial a Ride to go out. Some people enjoy a visit to the local pub. One person spoken to during the visits said that they would like to go on more trips. The home were busy planning for Christmas. The Salvation Army and church choir are Care Homes for Older People Page 18 of 35 Evidence: coming into the home and preparation has begun for the annual Christmas party for people that use the service, relatives, friends and staff. Of the fifteen surveys received from people who use the service three people said that they would like to do more activities the remainder were happy. Visitors are welcome at any time. There was a plentiful supply of visitors on the day of the inspection. The lunchtime of people with dementia who were eating in a temporary dining room was observed. The lunch time menu of the day was shepherds pie, mashed potato and peas. Staff said that people choose their meal the night before. Staff were available to help people but were not intrusive. A staff member suggested to a person who was nearing the end of their meal that they might be better with a spoon as there was a lot of gravy. The carer responded by taking the knife and fork away saying Ill give you a spoon, she didnt ask if the person would like a spoon. The person stood up thinking that their meal had ended. The lunchtime of people who reside on the older persons unit was briefly observed. Everyone was having shepherds pie. Tables were attractively set and some people had drinks with their meal. Relatives and visitors are welcome to join in mealtime, however need to inform staff before so that more food can be prepared. People spoken to during the inspection said that they liked the food, comments made included, They make my wife very welcome for lunch Weve been satisfied with everything Youre given a choice I enjoy the food 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive adult protection training which helps to ensure safety of people that use the service. Updating of the homes complaint and adult protection procedure would help to ensure that the appropriate people are contacted when needed. Evidence: The home has a complaint procedure, however this needs to be updated to include the names, addresses and telephone numbers of who to contact, timescales for action and advise of peoples rights to contact funding authorities if they want to make a complaint. This procedure would benefit from including contact details of funding authorities to help to ensure that complaints are dealt with promptly and appropriately. The home keep a record of complaints and action taken, however this did not include the two people who were mentioned earlier in the report who had spoken directly to the home owner. Surveys received indicated that people knew how to make a complaint and who to make the complaint to. Two people spoken to during the visit said that they were not aware of the homes complaint procedure other people said that they were. The home has an adult protection procedure. The procedure refers to dealing with any allegations of abuse swiftly in accordance with the National Care Standards Commission. The procedure should be updated to link to No Secrets, a Teeswide interCare Homes for Older People Page 20 of 35 Evidence: agency policy, procedure and practice guidance to assist staff in working together to identify and support adults who are vulnerable to abuse. This procedure should also be updated to reflect the change of regulator to the Care Quality Commission. The manager said that staff working at the home receive adult protection training twice yearly. Records were available to confirm that fifteen staff received adult protection training in July 2009. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The ongoing improvements and redecoration at the home will enhance the environment of people who use the service. The current programme of re-decoration, maintenance and renewal of fabrics has not been well managed to ensure the wellbeing of people with dementia. Inadequate communal space for people with dementia does not ensure their wellbeing. Evidence: Castle Court is situated in Boosbeck on the outskirts of Guisborough and Skelton. A bus service is available to transport people locally. The building was formerly an old school that has been converted into care home. The home is divided into two units. The ground floor of the home accommodates twenty eight older people. There is a large lounge, small lounge and dining room. There are twenty eight single bedrooms some of which have ensuite facilities consisting of a toilet and hand wash basin. The first floor of the home accommodates ten older people with dementia. Communal space consists of a combined lounge/dining room. There are ten single bedrooms one of which has ensuite facilities. There is a passenger lift. This inspection took place sooner than originally planned because we received an anonymous complaint about poor arrangements that had been put in place for caring for people with dementia whilst refurbishing the upstairs unit. The complainant said that people with dementia were using a small lounge downstairs whilst the first floor Care Homes for Older People Page 22 of 35 Evidence: was being decorated. The complainant said that there was insufficient space and that people with dementia had not been able to walk round any other part of the home. Other concerns included there not being any tables within the small lounge for people to put their drinks on and that there was not any room for visitors. The complainant advised that people that use the service were having to get out of bed early, washed and dressed and downstairs for 07:00am so that redecoration work could commence. Concerns were also raised about the homes security and safety of people as the main door is not locked. Following receipt of the complaint a decision was made to do an unannounced key inspection of the home. We arrived at 09:30 on 19th November 2009, explained the reason for the visit to the deputy manager and walked round the ground floor of the home. The deputy manager said that people with dementia were using the small lounge downstairs whilst the last phase of the redecoration took place. The room was small for eight people particularly as it contained two dining room tables. Two small tables were directly in front of two people. There was insufficient space to put other tables in the lounge. We walked round the first floor of the home and could see that corridor areas were in the process of being plastered and painted. At 09:50 am a person that uses the service was being helped into the passenger lift to come downstairs for breakfast. During the afternoon of the inspection a visitor was observed to be stood up in the small lounge as their was insufficient seating. It also became evident that the workmen were staying at the home and sleeping in the empty bedrooms registered for people who use the service until the refurbishment was complete. The home owner advised that the workmen were employees of the company and as such had been through a thorough recruitment procedure. The Care Quality Commission have advised the home owner that this is inappropriate, however if they choose to continue with such arrangements now or in the future they must identify any risks to people that use the service and inform the Care Quality Commission in writing how they are to safeguard people. It was observed that the front door of the home is left unlocked throughout the day. Numerous people were able to enter and leave the home without the knowledge of staff. The security and safety of people that use the service should be considered particularly those people with dementia. A walk round the home and a discussion with the manager identified that the redecoration programme was not being managed as well as it could be. A number of seats were available in the main lounge on the ground floor where people with dementia could have sat. In discussions prior to the inspection the home owner and manager of the home have advised that people with dementia are mixing with other Care Homes for Older People Page 23 of 35 Evidence: people living at the home. This could not be evidenced on the day of the inspection. The downstairs dining area could have also been used maybe by having two sittings at meal times. Since the last inspection a number of improvements have been made to the home environment. The main lounge on the ground floor of the home has been re-decorated and new curtains have been put up. The ground floor dining room has been redecorated and new dining room furniture has been purchased. One person spoken to during the inspection said, My room is very good, Ive got my own telly. The manager advised that re-decoration and improvement of the home is ongoing. It was noticed that a leak in the ground floor bathroom near to room 27 had marked the ceiling. Bedroom 31 on the first floor of the home also had a marked ceiling and wall paper was coming off the wall because of a leak. The manager advised that the leak had been fixed and that both rooms were to be re-decorated. The inspection of the service in December 2007 identified that a number of environmental changes had been made to the home. Changes to the first floor of the home meant a reduction in communal space for those people who have dementia. The home owner was asked to provide evidence that there was sufficient communal space for people who use the service, particularly those people who have dementia. The first floor of the home does not have enough communal space for ten people. The manager and home owner advised that some people who have dementia like to sit in the lounge on the ground floor of the home. They said that they wanted people who have dementia to mix with people who reside on the other people living at the home. This was not evidenced on the day of the inspection. The home owner has advised that they intend to create some more communal space on the dementia unit. Both sluices on the ground and first floor of the home would benefit from refurbishment. The plaster and paint in the first floor sluice was peeling off. The ground floor sluice sink contained cupboards that were bare wood and as such could not be cleaned properly. The home does not have a sluice machine that disinfects commode pots and urinals. The deputy manager said that commode pots and urinals are disinfected and left to soak on a regular basis. The laundry is a separate building to the home. The sluicing sink within the laundry was observed to be cracked , the deputy manager said that the sink was to be replaced in the very near future. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A high number of care staff are trained to a minimum qualification of NVQ level 2 in care which helps to ensure that peoples needs are met. Training records were disorganised and did not reflect that mandatory training for staff was up to date. Evidence: At the time of the inspection there were twenty six people using the service. Eighteen people were residing on the older persons unit and eight people residing on the dementia unit. Duty rotas looked at during the visit informed that there were four or five care staff on duty from 7:00am until 1:30pm and from 1:30pm until 8:45pm there are four care staff on duty. On night duty there are two care staff. In addition to care staff there is a nurse on duty during the day and night. People spoken to during the inspection thought that there were enough staff on duty to meet their needs. Of the five staff surveys received three people thought there were sufficient staff on duty two did not. Seventeen out of twenty three care staff at the home have achieved a minimum qualification of NVQ level 2 in Care or equivalent. Some staff have achieved or are working towards achieving an NVQ level 3 in Care. Two files of staff working at the home were looked at during the visit. One file contained evidence that a good recruitment procedure had been followed. An Care Homes for Older People Page 25 of 35 Evidence: application form, two references and a Criminal Record Bureau Check was available within the file. The second file contained an application form and a Criminal Record Bureau Check, however only contained one reference. The reference, was not from the last employer or an appropriate person. Files contained evidence of a statement of terms and conditions and supervision. The manager said that all new staff complete an induction that meets with the standards as set by Skills for Care. The manager was unable to find the induction record for the two staff files looked at during the visit. She said that the home owner had been separating the recruitment and training records of staff working at the home. The manager advised that mandatory training is provided to staff on a regular basis. The manager has a training matrix, however this was confusing. Training records were disorganised. We were unable to determine training that had taken place and training that was due. Certificates of training did not match up to that detailed on the training matrix and on some occasions certificates were not available to confirm that training had taken place. Training records were available to confirm that the deputy manager had been on venepuncture training. Four other nurses had received palliative care training, one nurse had received training in infection control and another in de-escalation techniques. Care Homes for Older People Page 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality assurance monitoring systems are in place to ensure that the home is run in the best interest of people who use the service. Poor management of the redecoration programme at the home compromised the wellbeing of people that use the service. Evidence: The manager is a registered nurse who has a management qualification. The manager informed us on the day of the inspection that she is currently working her notice and would be leaving in early December 2009. She said that the home owner is actively recruiting for a new manager, however in the interim the deputy manager would be taking charge. The manager advised that she has attended numerous training days throughout the year to keep her skills and knowledge up to date. Since last inspection of the service an administrator has been employed to assist/support the manager with the day to day running of the home. Care Homes for Older People Page 27 of 35 Evidence: Records were available to confirm that meetings take place with people who use the service and staff to help to ensure that the home is run in the best interest of people who use the service. Surveys for people who use the service have been sent out this year asking them about the quality of life at the home. Of the fifteen responses received people were happy with care provided, helpfulness of staff and food provided. The manager said that she is to analyse the responses and make the results available to everyone. The home looks after money for people who use the service. Each person has an individual record which details money held and transactions. A sample of health and safety records were examined and in found to be in order. Records were available to confirm that the homes gas boilers, fire alarm and hoists had been serviced in the last twelve months. Water temperatures are taken and recorded on a weekly basis to ensure that they are within safe limits. Records were available to confirm that on average weekly tests of the fire alarm system take place. Training records were disorganised and did not confirm that mandatory training for staff is up to date to ensure safe working practice. As highlighted earlier in the report this inspection took place sooner than originally planned because we received an anonymous complaint regarding poor arrangements that had been put in place for caring for people with dementia whilst refurbishing the upstairs unit. The findings of this inspection were that the programme of re-decoration had not been well managed to ensure the health safety and welfare of people. Care Homes for Older People Page 28 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 29 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 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 9 13 Medication must be given as 19/11/2009 prescribed and a record made at the time that it is given. This will ensure that people receive their medication correctly and the treatment to their medical condition is not affected. 2 20 23 The registered person must 30/01/2010 ensure that there is sufficient communal space for people who use the service, particularly those who have dementia. The registered person must advise the Care Quality Commission in writing of the amount of communal space in square metres for each person on the older persons unit and the amount of communal space in square metres for each person on the dementia unit. Page 30 of 35 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure the health safety and wellbeing of people that use the service. 3 26 23 The registered person must ensure that appropriate sluicing facilities are provided. This will help to prevent the spread of infection. 4 29 19 The Registered Person must 19/11/2009 ensure that any workmen staying at the home are fit to have regular contact with people who use the service. A thorough recruitment procedure must be followed. This will ensure the protection of people who use the service. Evidence must be available on staff files to confirm that induction training has taken place. This will help to ensure that staff are trained and competent to do their job. 6 30 13 The registered person must 31/01/2010 ensure that mandatory training is up to date and that certificates are on file to confirm that training has taken place. 31/01/2010 28/02/2010 5 30 18 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 will help to ensure that staff are trained and competent to do their job. 7 38 13 If the Registered Person chooses to allow employees of the company to stay/sleep at the home then risks to people who use the service must be identified and safeguards put in place. The Registered Person must inform the Care Quality Commission in writing of safeguards that are to be put into place. To maintain the health, safety and wellbeing of people that use the service. The registered person must ensure that the home redecoration programme is managed well. Unnecessary risks to health or safety must be eliminated. To ensure the health, safety and wellbeing of people that use the service. 30/12/2009 8 38 13 19/11/2009 Care Homes for Older People Page 32 of 35 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 7 Care Plans should be reviewed and evaluated on a monthly basis or more often as needed to ensure that care needs are being met. Risk assessments for people that use the service should be signed by a multidisciplinary team including the person who uses the service to confirm that they were the best and safest option to mainatin safety. Assessments should be completed and reviewed and updated on a regular basis to help to ensure that care needs are met. Care plans should be individual and specific to the person. Care plans should be developed to include what the person can do for themselves, assistance needed, likes, dislikes, evidence of personal choice and preferences. This will help to promote Independence, ensure that care needs are met and that care is delivered in such a way that is acceptable to the person. The Registered Person should ensure that care plans are developed for each assessed need for people using the service to ensure wellbeing. Care plans should be developed for those people who have a catheter. A record of medication competency assessments should be kept to enable staff to review their practice and confirm that assessments have taken place. Medication carried over from the previous month should be documented to on to the MAR to enable auditing. Correct codes should be entered on MAR charts to explain why medication has not been given. MAR charts should detail if a person is self administering their medication. The complaint procedure should be updated to include the names, addresses and telephone numbers of who to contact, timescales for action and advise people of their right to contact funding authorities if they want to make a complaint. This will help to ensure that complaints are dealt with promptly and appropriately. The adult protection procedure should be updated to link to No Secrets, Teeswide inter-agency policy, procedure and practice guidance. This procedure should be updated to Page 33 of 35 2 7 3 7 4 7 5 7 6 9 7 8 9 10 9 9 9 16 11 18 Care Homes for Older People 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 reflect the change of regulator to the Care Quality Commission. 12 19 The registered person should re-decorate the bathroom near to room 27 and bedroom 31 following the leak to enhance the environment of people who use the service. The cracked sluicing sink in the laundry should be replaced. This will help to prevent the spread of infection. The manager should ensure that two appropriate references are obtained for people who are to work at the home. To ensure a thorough recruitment procedure is followed and people are safeguarded. 13 14 26 29 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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