Inspection on 09/06/10 for Cavell House

This inspection was carried out on 9th June 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cavell House 16/06/08

Cavell House 18/07/07

Cavell House 27/04/06

Cavell House 19/09/05

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for older people Name: Address: Cavell House Middle Road Shoreham-by-sea West Sussex BN43 6GS     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Edward McLeod     Date: 0 9 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Cavell House Middle Road Shoreham-by-sea West Sussex BN43 6GS 01273440708 01273441483 cavellhouse@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr John Olley Type of registration: Number of places registered: care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 52 The registered person may provide the following category/ies of service only: Care home with nursing - 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 - OP Date of last inspection Brief description of the care home Cavell House is a care home with nursing situated in the town of Shoreham by Sea. The establishment has been extended and adapted to provide accommodation for up to fifty-two service users in the category of older persons, over the age of 65years (OP). The establishment consists of the original building, which was a local authority care home and a new annex. The majority of the home is on one level, however one section of the older building has Care Homes for Older People Page 4 of 31 Over 65 52 0 Brief description of the care home two floors, accessed by stairs and a passenger lift. The service provider is Ashbourne (Eton) Ltd. The most recent reports are made available to residents and relatives on request and a copy is displayed in the main entrance of the home. The responsible person on behalf of the company is Mr Mark Cash. The registered manager is Mr John Olley. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was arranged as recent safeguarding issues in the home had indicated a need for the Commission to carry out an assessment of the quality and safety of the care provided. In preparing for this visit we obtained from the service their annual quality assessment audit (the AQAA), and received completed Care Quality Commission (CQC) survey forms from ten people living in the home and from seven staff working at the home. Some of this information has been included in the writing of this report. We also looked at information we had received from others, such as a safeguarding report from the local authority and complaints concerning the service. Our visit was carried out by one inspector on the 9th June 2010, who was on the premises for seven hours. Care Homes for Older People Page 6 of 31 At the visit we spoke with five people living in the home, three relatives, the home manager and the providers area manager, and five staff working in the home. We sampled recruitment, training and supervision records for five staff, and preadmission assessments, care plans and activities records for five people living in the home. Other records sampled during our visit included the record of complaints and records relating to health and safety issues. As significant shortfalls in the service provided were identified at this visit, the Commission held a Management Review Meeting on 17/6/10 to consider what enforcement action, if any, we will be taking. The outcome of this meeting was that a warning letter will be issued to the provider, and that a planned review on the service and a compliance visit concerning medication procedures in the home will be carried out by January 2011. The provider will also be asked to send us an action plan to tell us what immediate and ongoing action they will be taking to put things right. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 31 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 9 of 31 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. People are confident that the 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. Evidence: At our visit we sampled assessments of the needs of five people which were carried out before admission was agreed. These assessments indicated that the home was visiting people to find out about their needs, such as medical, support and social needs, and recording these with a view to this information being used to set up a care plan for them when they enter the home. Care Homes for Older People Page 10 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is not ensuring that each persons health, personal and social care needs are being met. Care plans are not providing sufficient guidance for staff in meeting the persons needs, for example where they have challenging behaviour or dementia care needs. The persons choices are not always being fully respected. If people cannot manage their medication the home is not ensuring that they are being supported with it in a safe way. Evidence: We are told in the AQAA (the Annual Quality Assessment sent to us by the service) that each persons care plan is reviewed monthly by a named nurse, and that summaries of each care plan have been created so that all staff are aware of each residents abilities, needs and wishes. We read the notes of a meeting of care staff on 14/4/10 and one of the issues raised Care Homes for Older People Page 11 of 31 Evidence: by the manager at the meeting was of care plans not being regularly updated. We looked at the care plans for five people living in the home and found that where the person was confused or suffering from dementia, care plans were not setting out comprehensive guidance for staff on meeting the persons mental health needs which was based on an accurate understanding of their needs. For example, the care plan for one person tells us he suffers from cognitivie impairment and dementia, but the care plan does not record his likes and dislikes or how he prefers his care to be provided - this would assist staff in uderstanding and meeting his needs. The care plan tells us that staff should promote good communication with him but does not set out for staff how this should be done and the knowledge they have about how his attention can best be engaged. We talked to one person who is cared for in bed who told us they had been a professional singer, and still wanted opportunities to sing for others. We found that the care plan did not refer to this, and did not evidence that her interest in singing would be supported. The photographs and statues in her bedroom indicated that she had a strong religious faith, and she said she would like to be visited by a representative of her faith. We found that her care plan did not refer to her religious needs, and did not evidence how they would be supporting her with her wishes about practising her religion. Staff training records we sampled indicated that only two care or nursing staff had completed training in caring for people with dementia. We also observed two people who were confused an who we were not able to hold rational conversations with, who were being cared for in bed and appeared unable to use their call bell. On different occasions we heard them calling out for help which did not come. One person who was bed bound, talked in a confused manner, and had communication difficulties was shouting and banging a table for assistance on five occasions between 11.10 a.m. and 11.40 a.m. We observed that the only one of these occasions on which staff responded to her calls was when we brought it to the attention of a nurse on duty - although the nurse on duty was about thirty yards from the persons open door and in a position to hear them calling out. We read the notes of a care staff meeting held on 14/4/10 at which the manager had reminded staff of the need to be professional in their conversations with people and to Care Homes for Older People Page 12 of 31 Evidence: observe their dignity. Some of these issues had also been raised by relatives and representatives of people living at the home at a relatives meeting on 6/4/10, the report of which we read at this visit. In our survey forms we ask do the staff listen to you and act on what you say?. None of the ten people living in the home who responded to our survey ticked the box to respond always, five people ticked the box usually and five people ticked the box sometimes. One person wrote on the form that staff needed to be a little more understanding of our needs. One person we spoke to during our visit told us she is being assisted to bed earlier than she wishes to go to bed - for example when it is still daylight. The person also has mobility problems and said the remote control for her T.V. is often left out of her reach. Both of these examples indicate that staff are not maintaining or practising an awareness of her needs. We also found evidence that staff are not always fully respecting the persons choices. One person told us that if she doesnt want a shower at a particular time staff get cross if you dont want one and that staff got irritated when I didnt want an evening meal. In their survey form one person told us I would like to be able to come out of my room, and a second person also said in their form that they wanted to be helped to spend more time out of their bedroom. During our visit we spoke to one person who is cared for in bed and one person with mobility problems who said they would like to be assisted to go to the lounge rather than stay in their bedroom. One of them said that they had already asked staff that morning to go to the lounge, as she didnt like staying in her bedroom, but that this had not yet been arranged. We brought this to the attention of the nurse on duty and it was only then that the person was assisted to go to the lounge. We found therefore, that although the manager had talked to care staff at their meeting on 14/4/10 of the need to have professional conversations with people and to observe their dignity, that people were telling us in their survey forms that at times staff were not talking to them in a professional way or in a way which showed respect towards them. The ten people living in the care home who completed CQC survey forms told us in their forms that the home makes sure they get the medical care they need. Care Homes for Older People Page 13 of 31 Evidence: While reading a care plan, we found that a catheter change for one person was overdue. We discussed this with the nurse on duty who checked her records and told us that this had been missed and would now be written into the diary to be done. We are told in the AQAA that monthly medication audits are undertaken and audited against agreed policies and proceedures. Medication training is provided for all nurses and senior care staff. During our visit we observed a nurse dispensing medication and discussed medication arrangements with two nurses and the manager Mr Olley. We observed that medication which was prescribed to be given at 8 a.m. was being given to several people after 10.30 a.m. and to one person at 11.25 a.m. We asked a nurse on duty about this and she said that due to other duties the morning medication round routinely does not commence until 9 a.m. We asked the registered manager Mr Olley about medication routinely being given late, and if the possible negative effects of the individual receiving their medication up to a number of hours late had been risk assessed. Mr Olley was not able to provide written risk assessments concerning this. We also noted that on the morning of our visit one medication due to be given at 8 a.m. had been recorded on the Medication Administration Record as given but we then observed a nurse removing the medication from the medicine trolley and taking it away to administer at 11.25 am. The nurse then returned to the medication trolley and signed the medication record in the same box where the first signature had been written. We spoke to the relative of one person, who needs support with medication due to memory problems, and he told us that on the previous day he had found medication on the side cabinet in her room and that he had brought this to the attention of staff. He said he didnt know what the medication was or what it was for. Care Homes for Older People Page 14 of 31 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. People are not always being supported to follow personal interests and activities or to maintain contact with a representative of their religion. People are not always being supported to make the most of their abilities. People are able to keep in touch with familly, friends and representatives. People have nutritious and attractive meals and snacks at a time and place to suit them. Evidence: On the day of our visit activities taking place included making scones and cakes, and we observed ten people taking part in a bingo session. The manager told us that one of the activitity co-ordinators had left and that it was proving difficult to employ a new person with suitable skills for the post. The activity co-ordinator we spoke to told us that the impact of this was that they were still able to run group activities but that one-to-one activities time, for example Care Homes for Older People Page 15 of 31 Evidence: with people who were cared for in bed, was not taking place. We looked at the activities records for five people. We found that three of the people were taking part regularly in activities. Records indicated that one person (who has mobility problems) had last taken part in activities in September 2009. and one person (who is bed-bound) had last taken part in activities in March 2009, and the activites co-ordinator told us that they were the most recent activities records they had for those two people. We talked with the two people and found they both had good memories and active minds, and had interests (for example singing) which could be supported by staff. One person we spoke to who was bed bound and who was a practising catholic told us she would like to receive communion, but had not been asked if she would like support in arranging a representative of her faith to visit her. We discussed this with the manager Mr Olley who told us that it is arranged for the representatives of some faiths to visit the home, but not a representative of the faith of the woman we had talked to. Mr Olley said he believed that this should be looked into. Peoples relatives are encouraged to visit and to take part in relatives meetings. We spoke with the relatives of three people living in the home who all told us that the home keeps them informed about the care of their loved one. One person wrote in their survey form that I enjoy the meals and the activities because we get to choose what we want to do. We observed the serving of lunch. People were having lunch in their bedroom if they wished this, and people who needed assistance with eating or cutting their food were receiving this help. Care Homes for Older People Page 16 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns about their care they are not always sure what to do about this. The care home is not always safeguarding people from neglect. Evidence: The manager tells us in the AQAA that all complaints and concerns are recorded and outcomes (and) timescales are recorded in complaints folder. Two of the ten people living in the care home who completed CQC survey forms told us in their forms that they did not have someone they could speak to informally if they were unhappy, and five of them told us they did not know how to make a formal complaint. This indicates there is a need for managers to make people living in the home and their representatives more aware of the complaints procedure, and for people to be able to feel that they can approach staff with their concerns or complaints. At our visit we looked at the records of four complaints which alleged poor and unprofessional behaviour by some members of staff. We found that the complaints had been recorded and investigated, and documents Care Homes for Older People Page 17 of 31 Evidence: sampled included statements by members of staff. We found that verbal feedback but not a written outcome of the complaint had been given in each case. Records of staff meetings which we sampled indicated that some of the issues raised in the complaints had been discussed as a wider issue in staff team meetings. We discussed the complaint evidence with Mr Olley, who told us that no disciplinary action against staff had resulted from the outcomes of the complaints. On seperate matters a safeguarding investigation had been carried out by West Sussex County Council into some events at the home which had recently concluded that improvements needed to be made to some aspects of nursing practise and care records in the home. Minutes of recent staff meetings which we sampled at this visit indicated that action has been taken to address the issues raised, and Mr Olley updated us on how the recommendations of the local authoritys report have been carried out. We have evidenced in the Health and Personal Care section of this report that some people in the home are being left at risk of neglect, for example if they are unable to use a call bell and there are not always staff close enough to hear their calls for help. Allegations made in complaints received by the home, and some of the issues reported to us during our visit by people living in the home also indicate that peoples choices and dignity are not always being respected by staff. A requirement has been made that the provider take action to ensure that people are not suffering from harm or abuse or placed at risk of harm or abuse. Care Homes for Older People Page 18 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. Evidence: While the building is old, the home, grounds and gardens are being well maintained, and some significant improvements have been made to the premises. The first floor of the home has been refurbished to create a ten bedded unit with a dining room, lounge and bathing facilities which have all been refurbished and updated to a high standard. Profiling beds have also been purchased. Security in the home has been enhanced by improvements to fire detection monitors, emergency lighting, and by keypad locks on the lifts and the first floor unit. All bedrooms are being decorated prior to new admissions, and a number of bedroom carpets have been replaced in the last 12 months. Care Homes for Older People Page 19 of 31 Evidence: Bedrooms visited indicated that people are supported to personalise their bedrooms and make them their own. Two toilets and a shower room have been refurbished, and equipment purchased has included a specialist bath, new hoists and commodes. All areas of the home visited were clean and odour-free. Care Homes for Older People Page 20 of 31 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. People are not receiving appropriate support as there are not enough competent staff who have received the relevant training on duty at all times. The home has not evidenced to us that all required checks have been carried out to make sure that staff are suitable to care for people living in the home. Evidence: The AQAA tells us that robust recruitment policies are in place, all staff have a CRB, PoVA check and two satisfactory references obtained prior to appointment. We sampled the recruitment records for four staff working in the home and found the records to be incomplete. The day after our visit Mr Olley phoned us with some further information on checks carried out, but the information still did not evidence that required checks had been obtained for staff before they began work in the home. Mr Olley agreed that the staff records available remained incomplete and did not evidence that robust staff checks and staffing records were in place for all staff. Observations during our visit and discussions with people living in the home indicated that staff were not always able to meet their needs. For example, we documented a Care Homes for Older People Page 21 of 31 Evidence: number of times during our visit when staff were either not available or on hand to attend to people being cared for in bed who were unable to use their call bell. It is also evidenced in the Lifestyle section of this report that there is a lack of records to indicate that people who are bed-bound and some who need assistance with mobilising are having their social needs met. Care plans sampled did not show us that staff understand the individual needs of people suffering from memory loss or dementia, or that the needs of people with dementia can be met in the home. Training records we sampled indicated that only two of the care and nursing staff in the home have had any training in working with people with dementia, and none of the staff in the home have received training in working with challenging behaviour. Mr Olley advised us that training was being offered to staff in dementia awareness on 3/6/10, 10/6/10, 17/6/10 and 24/6/10. We also saw a poster advertising this training on the notice board in the ground floor nursing office. We asked Mr Olley how many staff would be doing this training, and Mr Olley told us that at that time no staff had put themselves forward for this training. Records we sampled of recent staff meetings in the home indicated that managers are concerned by the low take-up of training by staff, and in the AQAA the manager acknowledges that there is a need for more staff training in infection control and health and safety. The seven staff who responded to our CQC survey told us that their induction training covered the things they need to know to do the job when they started. The AQAA tells us that National Vocational Qualification (NVQ) training has been restarted for care staff, and that 14 of the 34 permanent care workers have NVQ at least at level 2, and at our visit the manager told us that five staff are presently doing NVQ training. Care Homes for Older People Page 22 of 31 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. Managers for the service have failed to ensure that care which keeps them safe and meets all their needs is being provided. If people 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. Evidence: We are advised in the AQAA that the manager is an experienced nurse and manager and is presently undertaking the Care Management in Practice award. At our visit the manager Mr Olley told us that he is a registered nurse, but that as his main experience had been in working with people with a learning disability that the clinical supervision of nurses in the home was being carried out by the deputy Care Homes for Older People Page 23 of 31 Evidence: manager. We were concerned to note at this visit evidence that managers of the home have been alerted to allegations of poor and abusive practice by staff - for example the four complaints received by the home which have been recorded since our previous visit, and in the record of the relatives meeting attended by Mr Olley on 6/4/10. It will be noted in other sections of this report that people living in the home told us during our visit that their needs are being neglected by staff. At this visit we also found that the needs of people receiving care in bed were being neglected. We have therefore noted that although managers had been aware of neglectful practice taking place in the home prior to our visit, neglectful practice in the home was continuing at the time of our visit. It is our conclusion that action taken by managers, for example discussing some of the issues in staff meetings, has failed to address the problems and protect people living in the home. The AQAA tells us that there are monthly audits for accidents and incidents, medication, bed rail safety, and pressure area care in the home. We sampled the audit dated 22.5.10 of medication provision in the home, and found that it had not identified the issue with morning medication routinely being given later than the prescribed time. There are regular meetings for relatives in the home, and there was evidence that issues raised by relatives or through the complaints and safeguarding procedures are discussed in meetings with staff. There is some evidence that managers listen to comments made by people with an interest in the service, and have taken up suggestions made about how to improve the service. For example, a relative we spoke to said someone suggested it would be helpful to people living in the home if a photograph of their key worker could be placed in their room, and that this had been done. We are told in the AQAA that where small amounts of money are held for people living in the home that this is dealt with by the financial administrator and checked by the Care Homes for Older People Page 24 of 31 Evidence: home manager and operations manager. Records of recent staff meetings we sampled indicated that while a system of staff supervision is in place, regular staff supervision is not always taking place. Supervision records we sampled indicated that the supervision provided is not always one to one sit down supervision, but may instead be discussions about clinical practice or observing the member of staff carrying out a task. Supervision records we sampled did not evidence that the individual development or training needs of staff were being assessed or discussed as a regular part of one-toone supervision. The AQAA tells us there are plans to commence staff appraisals. A requirement which includes staff supervision has been made in the Staffing section of this report. Care Homes for Older People Page 25 of 31 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 26 of 31 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 7 15 The registered person must 30/09/2010 ensure that the service users plan is setting out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. Care plans are not setting out how all the persons care needs are to be addressed. 2 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home, and that medicines are administered according to prescription. Medicines are not being administered at the times prescribed. 19/07/2010 Care Homes for Older People Page 27 of 31 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 3 10 12 The registered person shall 30/09/2010 make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. People living in the home do not believe their choices are being respected. 4 13 16 The registered person shall consult service users about their social interests and make arrangements to enable them to engage in local, social and community activities, and to follow their beliefs or religion. Some people living in the home are not receiving a level of social support which meets their expectations. 30/09/2010 5 16 22 The registered person shall 30/09/2010 ensure that people living in the home and any person acting on behalf of a person living in the home understand how the complaints procedure can be used. Not all people living in the home are aware of how to use the complaints procedure. Care Homes for Older People Page 28 of 31 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 6 18 13 The registered person shall make arrangements by training staff or by other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Some people living in the home are at risk of neglect. 30/09/2010 7 27 18 The registered person shall, 30/09/2010 having regard to the size of the care home, the statement of purpose and the number and needs of service users, ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Staffing arrangements are not ensuring that the needs of the people accomodated are being met. 8 29 19 The registered person shall 30/09/2010 not employ a person to work at the care home unless he has obtained in respect of that person the documents specified in Schedule 2 of the Care Homes Regulations 2001. Care Homes for Older People Page 29 of 31 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 Staff records held in the home do not evidence that all required checks and references have been obtained for all staff before they commence work in the home. 9 30 18 The register person shall ensure that persons employed by the registered person receive training in the work they are to perform and are appropriately supervised. Not all staff are receiving the training and support they require to meet the needs of the people accommodated. 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 30/09/2010 Care Homes for Older People Page 30 of 31 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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