Inspection on 30/06/09 for Centenary House

This inspection was carried out on 30th June 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Centenary House 22/04/09

Centenary House 30/10/08

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for older people Name: Address: Centenary House 70 Charlton Road Shepton Mallet Somerset BA4 5PD     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: Justine Button     Date: 3 0 0 6 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 32 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 32 Information about the care home Name of care home: Address: Centenary House 70 Charlton Road Shepton Mallet Somerset BA4 5PD 01749342727 01749342727 caremanager@centenaryhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Centenary Care Homes Ltd care home 16 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 accommodates is 16. The proposed refurbishment of the first floor must be complet and deemed `fit` for purpose by the CSCI, which will include a further site visit, with no more than four bedrooms being added which meet or exceed 12 sq m before they can be used for prospective service users. Suitable access, other than stairs, to the first floor must also be available for service users. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Centenary House currenty provides residential care services for up to 13 people over the age of 65. The home faces a busy road but is within walking distance to the centre of Shepton Care Homes for Older People Page 4 of 32 Over 65 16 0 3 0 1 0 2 0 0 8 Brief description of the care home Mallet. There is a convenience shop in a garage next door and a large supermarket nearby. There is car parking in front of the home. The home comprises the original house and a later extension. All service users rooms are on the ground floor. The first floor is currently unoccupied. Many of the bedrooms have individual access to a pleasant garden and two have access to a side patio. There is a double bedroom with en-suite facilities. There are two lounges, a pleasant conservatory overlooking the garden and a dining room. There are two communal bathrooms, one has been redecorated and fitted with a spa bath. The shower room has been refurbished and now has a good sized walk in shower cubicle. The fees at the home are 390 to 430 pounds per week. Care Homes for Older People Page 5 of 32 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: This inspection was carried out over an 6 hour period by one inspector. During the inspection a tour of the premises was made and individuals living at the home were seen and spoken with both in private and in the communal areas of the home. Surveys were sent out to people living at the home and to staff. Their comments are incorporated into this report. The last key inspection at the home was conducted in October 2008. At this time the home had a manager and the standard of care and support afforded to people at the home was assessed as good. In the period between January and March 2009 the home was without a manager. At this time we received concerns with regard to the running of the home and the care and support given to people living there. As a result of these concerns we conducted a random inspection and shared the findings of this inspection with Somerset County Council. The County Council have the Care Homes for Older People Page 6 of 32 lead role in implementing the safeguarding Adults policy and are responsible for the funding of some people living at the home. A joint investigation into the concerns was then completed. This included meeting with the new home manager, interviewing staff, reviewing the care needs of the people living at the home and meeting with the providers or owners of the home. As a result of the investigation several areas of concern were expressed to the owners and agreement reached on the actions required to rectify these issues. This inspection was conducted to follow up the actions required and to ensure that the home is now running to an adequate standard. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 32 Part of the concerns riased to us related to the financial viability of the home. These concerns have been investigated and reassurances given by the providers that the home remains viable. To confirm this however it was agreed that the providers would provide both CQC and Somerset Social Services with copies of the homes audited accounts. To date these have yet to be received. The home owners have informed us that these will be forwarded to us as soon as possible. As previously stated however it should be noted that people living at the home have not been effected by any lack of monies been made available. During the period that the home was without a manager it was the responsibility of the providers/owners to ensure that the home continued to run to an adequate standard. This was not completed to the fullest extent. The providers now also need to develop the system of feeding back to the manager any concerns as a result of the monthly visits and to develop an action plan to agree how any identified issues would be resolved. It was clear from the discussion/ interviews with staff that they did not feel that they had a working relationship with the providers. This was fed back to the providers at the end of the investigation. The providers gave assurances that they would complete some work with the staff to improve this relationship. To date it could not be confirmed that any action has been taken in this area although some systems are planned and due to be implemented. As a result of the environmental audits completed by the manager several areas of the environment need to be updated to reduce the health and safety risk to people living at the home. These now need consideration by the providers. During the inspection it could not be confirmed that the home had completed a electrical hard wiring check. These are required every five years to reduce the risk of fire caused by an electrical fault. During the inspection an upstairs store room was seen. This room had been locked at the last inspection. The room contained a large amount of paper work that was not been stored in good order and may place the confidentiality of people living at the home and staff at risk. The care staff currently complete all of the social and recreational events. This may need to be reviewed if the numbers of people living at the home increase. 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 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 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 who are considering living in Centenary House and those close to them are provided with information about the home in a variety of ways. This information has recently been updated. All people moving to Centenary House have their individual care needs assessed before admission to the home is agreed. Evidence: At the last inspection it was reported that The registered provider has produced a statement of purpose and service user guide that give prospective people thinking of moving into the home and relatives information on the home and service. The manager stated that this information currently needs some minor updating to ensure that it clearly states the current managerial arrangements at the home and the services to be provided. It is advised that a copy of the statement of purpose be available in the reception area of the home to provide all interested parties with the Care Homes for Older People Page 11 of 32 Evidence: information at any time. People spoken to during the inspection stated that they felt that they had received enough information prior to moving into the home. Admissions to the home are not made until a full needs assessment is made. The registered manager receives the social worker assessment and then carries out her own needs based assessment. A sample of these was seen in the care plans. They were detailed enough for a decision to be made about whether the home can meet the persons needs. All people living at the home have been issued with a contract. At this inspection it was confirmed that the minor amendments required have now been made. Copies of information are now freely available within the home. Care Homes for Older People Page 12 of 32 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. A new care planning system has been developed and is due to be introduced. People living at the home can be assured that their individual health and personal care needs will be met and they will be treated with respect at all times. Medication is on the whole well managed. Evidence: Investigation in the concerns recently raised with regard to the home identified the lack of staff understanding with regard to the care planning process. Staff did not appear to have the knowledge and skills to develop, review and update the care plans which were in place. As a result of this the current manager has reviewed the care planning process. A new care planning system has been developed and complimentary training has been given to the staff. The new care plans were due to be implemented the day after this inspection visit. We spent some time with the manager discussing and reviewing the new care plans. The new care plans appeared to view the people Care Homes for Older People Page 13 of 32 Evidence: living at the home as individuals and the care plans clearly stated their individual needs and wishes. The plans demonstrated the individuals likes and dislikes. The plans were an improvement on those that were previously in place. As the plans had not yet been implemented we were unable to assess the care plans in any greater detail. The management now need to ensure that the new plans remain updated and that staff have the skills to ensure that they remain up to date and relevant. The new care plans now contain risk assessments for all areas including nutritional assessments and potential weight loss and for the risk of falls. The care planning process will be reviewed in more detail at the next inspection visit when they will have been in place for a period of time. Since the last random inspection and following meetings with the manager and providers we are now informed of any incidents or deaths that occur at the home. This is required under Regulation 37 of the Care Home Regulations. This has helped to demonstrate that the home meets the physical needs of the people living at the home. People spoken to during the inspection stated that they were able to see a doctor when required and that visits to dentists and opticians could be arranged. At the last inspection it was reported that people spoken to stated that staff were very kind and that they always knocked on your door before coming in. During the inspection, the inspector observed staff interacting with service users in a professional, kindly and respectful manner. Staff are friendly, but professional in their approach. These finding were confirmed during this inspection. Medication arrangements were not reviewed at this visit. These were found to satisfactory at the last key inspection. Care Homes for Older People Page 14 of 32 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 living at the home maintain control over their day-to-day lives and their opinions are sought in the running of the home. People living at the home are able to have visitors at any time and are confident that friends and family will always be made welcome. People living at the home are able to continue to practice their chosen faith. Evidence: Concerns raised to us related in part to the provision of activities and meals. At the last inspection it was reported to us that the provider/owner of the home regularly completed activities at weekends. This appears now not to be the case. The home does not employ an activities organiser. Activities are completed by staff following the completion of personal care. Due to the current low numbers of people living at the home this arrangement currently appears adequate however if the numbers of people living at the home increases this may need to be reviewed by the provider/owner. This will ensure that peoples physical, social or recreational needs are Care Homes for Older People Page 15 of 32 Evidence: not compromised. The new care planning system that has been developed documents peoples social history and hobbies and interests. No activities were on offer on the day of this inspection although people were observed watching television or reading and chatting. The home has a pleasant garden although access can be restricted for those people who have poor mobility (see outcome group for management). At the time the concerns with regard to the provision of food and diet were raised with us the home did not have a cook. At this time both the care staff and the provider were providing the cooked meals at the home. Not all the staff (including the provider/owner) had the necessary food hygiene certificates to ensure that the food preparation was completed in line with food health and safety. Since this time all staff who prepare food have now completed this training. A new cook has been employed. It cannot be confirmed who cooks the meals when the cook is having a day off. Feedback from people living at the home was very positive about the food that is served. The kitchen was well stocked with a range of foods including fresh fruit and vegetables. The lunch time meal on the day of the inspection was viewed. As the home is a relatively small home the cook stated that she was able to be flexible about the meals that she prepared.The weather on the day of the inspection was extremely warm and due to this the cook had prepared a salad. This included new potatoes, egg, cheese and ham. The cook told us that lunch consists of three courses everyday and prior to the salad home made vegetable soup was served. The cook told us that she was not aware of any budgets set for the ordering of foods and that she orders whatever she requires. Again due to relatively small size of the home the cook knows the people living at the home well and was aware of individual likes and dislikes. As such even though a choice of meals is not routinely offered individual needs are catered for. The kitchen was clean and tidy on the day of the inspection although the microwave and extractor fan were not in working order. Prior to lunch staff were observed helping people to the table. A choice of places to sit was offered. The table were nicely set with table cloths and flowers. Individuals living at the home stated that they are able to choose when they got up, when they went to bed and how they spent their day. people living at the home were very complimentary about the manager and stated that she frequently seeks their opinion. people are able to receive visitors when they want and that their visitors were made welcome. Care Homes for Older People Page 16 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People currently using the service are confident that the homes management team would appropriately deal with any complaints or concerns. Issues raised with regard to protection of people living at the home have now been addressed. Complaints received by the home are robustly investigated. Policies, procedures and training are available to staff to ensure they have the knowledge to prevent people from the risk of abuse. Recruitment procedures on the whole protect people using the service from the risk of abuse. Evidence: The home has a complaints policy which was display at the home and also available within the Statement of Purpose/Service User Guide One complaint has been received by the home since the last inspection. This complaint was investigated by the home manager in line with the homes complaints procedure and could not be substantiated. As discussed earlier in this report additional concerns have been raised to us. These concerns have been investigated in conjunction with Somerset County Council who have the lead role in investigating all safeguarding issues. As part of these investigations meetings have been held with the directors of the company and the home manager. Interviews were also held with staff. (see the outcome areas for Care Homes for Older People Page 17 of 32 Evidence: staffing and management for more details). The actions for the issues raised with regard to a staff member and her partner (who is not employed by the home) living in the staff accommodation at the top of the home have now been completed. This has included ensuring Criminal record Bureau checks has been obtained, arrangements for receiving visitors, confirming the areas of the home the partner of the staff member can access and inclusion of the accommodation in the homes fire risk assessment. This will help to ensure the safety and security of people living at the home. The concerns raised with us also related to an allegation of verbal aggression towards a person living at the home. Actions in response to these allegations have been agreed with the directors of the home. Care Homes for Older People Page 18 of 32 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. Centenary House provides a comfortable homely environment for the people living there. Individuals are able to personalise their individual rooms. Some issues have been identified in the environmental risk assessment which need consideration to protect the health and safety of people living at the home. Evidence: At the last inspection which was conducted in October 2008 it was reported that The home is an older style property that has been extended to provide accommodation for up to 13 service users. One room can be used as a double but is currently used for single occupancy. All bedroom accommodation is located on the ground floor. All areas are fitted with a newly fitted fire detection and call bell system. Communal areas consist of two lounges, a dining room and a conservatory. All have been furnished to meet the needs of the service users and provide a comfortable environment. It was noted that one carpet in a corridor would need replacing in the near future. The manager was aware of this. Outside there is a pleasant garden with seating for service users. Care Homes for Older People Page 19 of 32 Evidence: We viewed a selection of individual bedrooms and noted that all had been personalised to reflect the tastes and needs of their occupants. The majority of the rooms have glazed doors onto the garden. There are no other windows in these rooms but doors are fitted with ventilation vents to allow fresh air into the rooms. Only one bedroom has an en suite but there are adequate numbers of toilets around the home. There is one assisted bath and a walk in shower with seat. All bedrooms have wash hand basins. All laundry is completed in house and people spoken during the inspection stated that this was completed to a good standard. On the day of the inspection all areas seen by the inspector were clean and free from odours. The manager had completed a range of risk assessments with regard to the environment thus ensuring that the building remains fit for use. At this inspection it was confirmed that the new manager had updated the environmental risk assessment and that this had raised some areas that now need consideration by the home owners. These are discussed in more detail under Regulation 38 (management outcome) which is concerned with the health and safety within the home. It was also confirmed at this inspection that the carpet that was worn had now been replaced. Unfortunately this has not been fitted to a good standard and is unsatisfactory. The manager stated that she had been in touch with the suppliers who had agreed to come and relay the carpet. This was to happen in the weeks following the inspection. Care Homes for Older People Page 20 of 32 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. Staff training needs have been identified and training arranged for any shortfalls. Staffing numbers are adequate to meet the needs of people at the home. Night staffing arrangements are now adequate. Evidence: Staff recruitment files were not viewed on this occasion. At the last inspection it was reported that The home has a low staff turnover. Due to this only one staff recruitment file was viewed during the inspection. This showed that on the whole a robust procedure is followed. All staff recruited to work with in a care home are required to undertake a Criminal Record Bureau and POVA check. These had been completed for staff at Centenary House. There was evidence in the recruitment file of this individual that people living at the home had been involved in the recruitment process. In addition it has now been confirmed that people living in the staff flat at the top of the building have now completed a Criminal Record Bureau check. On the day of the inspection eight people were living at the home. The staffing levels seen were 1 domestic staff member,1 cook and two care staff during the day. In addition to the manager. There is 1 waking and 1 sleeping night staff. These levels appear to be adequate given the low numbers of people living at the home. Staffing Care Homes for Older People Page 21 of 32 Evidence: levels will need to be reviewed if the occupancy at the home increases. It was clear from the issues raised with us that sleep in staffing arrangements for night duty during the period January 2009 and March 2009 may not have been adequate in that these were covered by people who did not have the necessary skills and competencies to provide hands on care. The providers told us that there was a system in place to call staff into the home at this time in the event of an emergency. This has now been resolved with only staff with the appropriate skills and knowledge completing the sleep in cover. From the investigation conducted it was apparent that limited staff training had been completed following the last inspection which was conducted in October 2008 and the recruitment of the manager in March 2009. As a result of this we requested that the home develop and submit to us a training matrix. This request was complied with by the home manager. At this inspection it was confirmed that the training matrix had been kept up to date. This demonstrated that although the majority of training had been completed some training needs remain. Training is now planned on regular basis. Any shortfalls noted would be completed over the next few months. Care Homes for Older People Page 22 of 32 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. The home manager has the skills and experience to run the home. The manager has introduced some improvements into the home. The providers need to continue to build relationships with staff at the home. Record keeping at the home is poor in some areas, particularly the storage of archieved records and is not in line with Data Protection Act. Requests for supplementary information from the home owners has been requested but is yet to be received. We are therefore unable to assess if people living at the home are safeguarded by robust financial and managerial procedures. Appropriate steps have yet to be taken to ensure the health and safety of staff and people living at the home. Care Homes for Older People Page 23 of 32 Evidence: The current manager is Ms Ann Nicholson. Ms Nicholson has significant experience in the care and support of older people and the running of care homes. Ms Nicholson is in the process of making an application to become registered with us. This is required to ensure that managers have the skills and competencies to run a care home. Ms Nicholson has been instrumental in implementing the actions required as a result of the concerns raised. Comments received from both staff and people living at the home were very positive about the manager. As previously discussed in this report concerns had been raised to us with regard to the services provided at Centenary House. As a result of these concerns a random inspection was conducted and subsequent meetings were held with the providers/ owners. At the meetings and in the report following the random inspection requirements were made with regard to providing both Social Services, who are responsible for safeguarding the interests of people living in care homes, and us with additional information. To date this information has yet to be received. As part of the responsibilities of owning a care home the provider or owner must visit the service at least once a month. This is called a regulation 26 visit. The purpose of this visit is to form an opinion of the care and support provided at the home. This is done by talking to people living at the home, staff and by viewing records and documentation. During the visit the provider/owner should prepare a written report. Following the concerns raised to us we requested that the provider/owner submit copies of the last six months regulation 26 visits. We requested this order that we could monitor if the provider had taken appropriate action with regard to the concerns that had been raised and in order to ensure that the provider/owner had the skills and knowledge to identify any concerns and act on these accordingly. This will ensure that the people living at the home receive the appropriate care and support. During this inspection copies of two regulation 26 visits were available. These had been completed for April and May 2009. It was clear from the regulation 26 visit documentation viewed that during the April 2009 visit two staff had raised concerns with the provider with regard to staffing levels. It could not be confirmed from the documentation seen what action the provider had taken in response to these concerns. Following the regulation 26 visit the provider/ owner should discuss the visit with the manager in order that they can both agree on any actions required as a result of the visit. It is clear from the documentation seen that this is not always completed by the provider. This may be in part due to the fact the provider visits the home at weekends due to other work commitments. The manager may not always be available at this time. Although the manager and the provider have regular contact via e-mail and telephone calls both parties need to ensure that they meet at regular intervals at Care Homes for Older People Page 24 of 32 Evidence: the home to ensure that they can sufficiently monitor the care and support provided to people living at the home. Part of the concerns raised to us in May 2009 related to the financial viability of the home. The subsequent safeguarding meetings confirmed in part that the outcomes for people living at the home are not effected by any financial restrictions. However in order to confirm this and assess the on going financial viability of the home it was agreed that the most recent audited accounts would be forwarded to both Somerset Social Services and The Care Quality Commission. These accounts were requested to ensure that people had a long term secure place to live. A reminder was sent to the provider on the 13/07/09 again requesting that these accounts be forwarded to us by 21/07/09. At the time of writing this report these accounts have yet to be received either by us or Somerset Social Services. We have received a letter from the home owner stating that the accounts are currently being audited by the accountant and will be forwarded to us as soon as possible. It was clear from the issues raised with us and as a result of the subsequent investigation that the home was without a manager for the period January and March 2009. It was during this time that the overall monitoring of standards within the home was not robust. As a result of this areas such as staff training, care planning and staffing levels were not monitored to the fullest extent and appropriate action taken to resolve any issues identified. The Care Standards Act and the service specific regulations all say that an organisation must have a responsible individual (RI). The regulations state that the RI is responsible for supervising the management of that service. It is clear that during the time between January and March 2009 that this role was not completed robustly. Although the majority of issues raised with us have now been resolved the RI must ensure that they sufficiently monitor the home to ensure that the outcomes for people living there remain positive. This is particularly important when the home is without a direct home manager. The Care Home Regulations (12 (5)) states that that The registered provider (ie the owner usually the Responsible individual) shall, in relation to the conduct of the care home maintain good personal relationships and professional relationships with each other people living at the home and staff. It was clear from the interviews conducted, as part of the investigation, that staff did not feel that they had a good relationship with the owners and did not feel that they could approach them with any concerns they may have. This was feedback to the owners at the end of the investigation. The owners were surprised by the comments from staff as they felt that they had always encouraged staff to phone them with any issues. It was agreed however that there needed to be two way communication between staff and the owners. It was agreed at Care Homes for Older People Page 25 of 32 Evidence: the meeting that the owners should make themselves available at staff meetings so that they can be aware of situations within the home. Consideration would also be given to having a notice to staff to say when the owners would be in the home. At this inspection it was confirmed that although staff meetings had been arranged by the home manager that the owners had not attended this meeting. The owners had however written to staff with regard to the staff perception that a pay rise was due. The owners have told us that they intend to make themselves more available to staff by having a regular weekly time that they will visit the home. The manager will inform staff via a notice which day the owners are available. The owners need to consider how to continue to improve relationships with the staff team. During the inspection visit it was clear that other actions had been completed by the manager and the provider in response to the concerns raised. This included ensure the safety and well being of people living at the home by the completion of risk assessments. Assessments have been completed for the staff flat on the upper floor, a fire risk assessment and for the building as a whole. The risk assessments have however identified some areas of concern that now require action. The fire risk assessment identified that the side entrance to the home would be used as a means of escape in the event of a fire. This area however is very cluttered and overgrown. This would inhibit any means of escape. This area now needs to be cleared to ensure that people are not put at risk in the event of a fire. The risk assessment has identified that the pathways around the home are uneven. This would increase the risk of people living at the home falling. The provider now needs to consider rectifying this. This may also include increasing the access the grassed area of the garden to allow people with poor mobility to this area. The environmental risk assessment also identified that action is required at the front door of the building to aid the access for people with poor mobility. Maintenance records were viewed during the inspection. It could not be confirmed if and when the electrical system at the home was last checked. This is required to be completed every five years. The provider and and manager need to ensure that this is completed to reduce the risk of fire caused by an electrical fault. During the inspection a large amount of insecure paper work was seen in the upstairs store room. This include the care records of people living at the home, those that had left and staff details including personal telephone numbers, address and banking details. This room is also used as a store room for unused equipment, storage of food stuffs and chemicals for cleaning. As such the room is used frequently by staff and on the day of the inspection was left insecure. The paper work seen was unorganised and stored in plastic bags and boxes. The storage of paperwork in this way does not Care Homes for Older People Page 26 of 32 Evidence: comply with the Data Protection Act and could be open to abuse of not only people living at the home but staff. This needs to be rectified as a matter of urgency. Since the random inspection we are now being notified at regular intervals about death, illness or any other events occurring at the home. This is required under Regulation 37 of the Care Home regulations. Care Homes for Older People Page 27 of 32 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 28 of 32 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 32 10 The registered provider 29/10/2009 (Responsible individual) will ensure that they robustly supervise the management of the home in line with their responsibilities of the Care Home Regulations. To ensure that the manager has sufficient support and guidance in running the care home and to ensure that the home is run in the best interest of people living at the home. 2 34 25 The provider will submit the audited accounts for the home to CQC This is required in order that the CQC can be confident that the home is financially viable and thus providing people with a long term secure place to live. 29/08/2009 3 37 17 The registered persons shall review the storage of all 30/08/2009 Care Homes for Older People Page 29 of 32 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 records including those currently in the upstairs storage cupboard to ensure that they are secure, up to date and in good order in accordance with the Data Protection Act. This will ensure and maintain the confidentiality of people who have and who are living at the home and staff. 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 It is recommended that following the implementation of the new care planning process that the plans are kept under review to ensure that staff have the skills and competencies to complete these fully. The plans should continue to reflect the individual needs of the people living at the home. It is recommended that the provision of social and recreational opportunities be kept under review to ensure that the home meets the needs of the people living at the home. It is recommended that staffing numbers at the home are kept under review particularly if the numbers of people living at the home increases. It is required that all staff receive all necessary training in line with the current training matrix. It is recommended that the providers seek ways to improve their relationship with staff working at the home. It is recommended that the outcome of any regulation 26 2 12 3 27 4 5 6 30 32 33 Care Homes for Older People Page 30 of 32 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 visits are discussed with the home manager and an action plan devised to address any issues which have been identified. 7 38 It is recommended that the providers consider remedial action in line with the homes environmental risk assessments including upgrading the paths and access to the front of the building. This will reduce the risk of falling to people living at the home. The provider must ensure that fire escape routes are clear in line with the homes fire risk assessment . The provider must ensure that an electrical hard wiring certificate is obtained and that any remedial action required is taken. 8 9 38 38 Care Homes for Older People Page 31 of 32 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. 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