Inspection on 10/02/10 for Chasedale

This inspection was carried out on 10th February 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chasedale 21/01/10

Chasedale 27/10/09

Chasedale 28/01/09

Chasedale 22/04/08

Chasedale 29/10/07

Chasedale 02/11/06

Chasedale 02/02/06

Chasedale 20/06/05

Chasedale 06/01/05

Chasedale 11/08/04

Chasedale 09/02/04

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Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: Chasedale Tynedale Drive Cowpen Estate Blyth Northumberland NE24 4LH     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: Carole McKay     Date: 1 1 0 2 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 33 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 33 Information about the care home Name of care home: Address: Chasedale Tynedale Drive Cowpen Estate Blyth Northumberland NE24 4LH 01670-365997 01670365732 chasedale@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Robert Nelson Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who may be accommodated is 60. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 10 Dementia - Code DE, maximum number of places: 50 Date of last inspection Brief description of the care home Chasedale Nursing Home is a two storey, purpose built facility of traditional brick build and tiled construction. It is situated on the edge of a large residential estate approximately two miles from the centre of the town of Blyth. The home is well served Care Homes for Older People Page 4 of 33 Over 65 0 10 50 0 2 7 1 0 2 0 0 9 Brief description of the care home by public transport. The home has a car park to the front from which there is level access to the main entrance. There are grassed sitting areas, which are accessible to, and for the use of, residents and visitors. The home is registered to provide care to 60 persons 10 of which are the category of old age requiring nursing care and the remaining 50 under the category of dementia care (nursing). The home charges fees of between £444.60 and £504.60 per week depending upon the needs and requirements of the individual residents. As the home provides nursing care the free nursing care element of the funding is provided in addition to the costs charged to the resident. The home provides information about the service through the service user guide. A copy of the last inspection report is available in the entrance to the home. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is ONE STAR. This means the people who use this service experience ADEQUATE quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out: Before the visit: We looked at: Care Homes for Older People Page 6 of 33 Information we have received since the last key inspection visit on the 29 January 2009, and the random inspection carried out on 27 October 2010, including details of action taken by the provider. How the service dealt with any complaints and concerns since the last visit; Any changes to how the home is run; The Visit: An unannounced visit was made on the 10 and 11 February 2010 . During the inspection we: Carried out a Short Observational Framework Inspection (SOFI). A SOFI is carried out where people who live in a care home find it difficult to communicate with an inspector. This tool, developed with the University of Bradford, helps us to find out what people think of the care they receive; Talked with the manager; Looked at information about the people who use the service and how well their needs are met; Looked at other records which must be kept; Checked that staff have the knowledge, skills and training to meet the needs of the people they care for; Looked around the building to make sure it was clean, safe and comfortable; Checked what improvements had been made since the last visit. We told the manager what we found. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Provide more up to date information to service users and their representatives. Make sure the health care needs of all service users are met, to ensure the well being of all the people who live at the home. Make sure that the arrangements for managing the medication belonging to service users are safe and that audit arrangements verify that service users receive the medication they should have. This will protect service users and ensure their well being. Make sure that the social and communication needs of the more dependent service users who have dementia are met, to ensure the well being of all the people who live in the home. Provide adapted facilities and aids to independence so that peoples choices can be accommodated safely. Make sure that furniture, bathrooms, toilets and surfaces are clean to use at all times. Repair or replace worn furniture. Provide a better mealtime experience for people living on the all male unit. Make sure that all service users are safely assisted to use the lift. Review the laundry arrangements to ensure safe working practices are followed. Keep staff training and supervision up to date and make sure staff know how to use special equipment. Care Homes for Older People Page 8 of 33 Provide appropriate resources for the support of more dependent service users. This will preserve service users dignity. Take action to use the quality assurance auditing tools that are available to ensure that good standards of care are acheived and maintained. 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 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have the information they need but this is not up to date and clear. Evidence: Assessment was not a focus of the inspection as it was initially carried out as a random inspection. However the service user guide was examined to establish that information to do with lines of accountability and the process for raising concerns and complaints were both clear. The administrator said that the service user guide was issued to each person as part of a larger welcome pack. The manager provided us with a copy. The guide includes a description of the building and services, the aims of the service and the health and safety arrangements. Underpinning values are also described and there is a section that describes management. This section does not mention the role of the Deputy Manager. The complaints procedure is not a description of the organsiational procedure and should be amended to refect this. Care Homes for Older People Page 11 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user health care needs are not being addressed consistently. Evidence: Four care plans were examined. The care of the service users that the care plans related to was case tracked. This means that, where we could, we spoke to the individual residents or observed their care then matched our observations to what was written in the care plan. The first care plan did not match the current care needs of the individual. The plan had been rewritten in June 2009 and had not been evaluated since then. The manager was aware that care plans were not up to date and said that there was a rolling programme of updates and this was one that had not yet been addressed. However, this resident had been very ill and was said to be on end of life care pathways, therefore her plan should have had some revision. The plan did not provide staff with sufficient information to meet her current care needs at such a critical time. When we spoke to staff about the residents care needs they told us that she was starting to eat and drink a little better, she was nursed in bed on a pressure relieving mattress and required regular turns to prevent complications of bed rest. Staff did not know if the resident was to be turned every two hours or every three Care Homes for Older People Page 12 of 33 Evidence: hours, this was not documented on her care charts.The pressure relieving mattress was set on number one. Care staff did not know what this number corresponded with, they stated that nurses were responsible for setting the pressure. However, the nurses were also unaware of what the numbers on the mattress indicated. The resident did look clean and well cared for, she appeared to be comfortable in the bed and staff were very attentive to her needs. The second care plan did reflect the actual care needed by the resident. The care plan contained appropriate assessments and clear plans of care which had been regularly evaluated. This resident was also nursed in bed on a pressure relieving mattress, the setting for this mattress was a different type and was indicated by the actual weight of the resident. The mattress was set for the correct weight of this resident. The resident looked clean and well cared for however, she was wearing ankle socks on her hands. When questioned care staff said that this was to prevent her from scratching her face. Another resident on the same unit was also wearing socks on her hands. Whilst the intention was good and showed a caring attitude, the practice is institutional, where residents are at risk of scratching their face advice needs to be sought from the correct professional, such as an occupational or physical therapist. The third care plan we looked at included an in- house assessment profile completed in February 2010. Risk assessments had been updated at the same time for moving an handling and pressure sore risk. The person was sitting in the lounge in her nightdress. When staff were asked about this they explained that the person could be resistant to personal care on first getting up, but liked to come along to the lounge. This was reflected in the service user plan and there were strategies for dealing with this. The service user plan also contained a Four Seasons nutritional risk assessment completed in April 2009, but no overall score had been entered. Reviews were dated up to 19 October 2009 with an entry no change against these. A specialist MUST tool had been completed in May 2009 and a monthly weight record was being kept. However there was no entry since 2 August 2009, when a loss of 1.15kg was recorded. All care plans for this person had an evaluation in February 2010, though none had been recorded before this since October 2009.Food and fluid intake was reported on daily up to 9 February 2010. The fourth file we examined was up to date in all aspects. Homes have to notify us of accidents and incidents. We examined this file because we had been notified about an incident in respect of the person by the home. This matter was recorded in the file and a risk assessment had been carried out with preventative action taken to avoid the same ocurrence. Care Homes for Older People Page 13 of 33 Evidence: Throughout the home residents looked clean and well cared for, their fingernails were clean and they were dressed in clean clothes. Staff were attentive to residents and were helping them to eat, drink and dress in a sensitive manner. Staff were able to tell us which residents required help with eating and drinking, including those residents who needed their food and fluid intake recorded. We examined the records of the food and fluid intake for three residents. One resident had just started on fluid balance records, these showed that she had been offered sufficient fluid that morning. The records for the remaining two residents were inconsistent. It appeared that on some days residents did not receive enough fluid, or the fluid they did receive was not recorded. We observed the care on the 10 bedded nursing unit. Five of the residents on this unit were nursed in bed. All of these people were very dependent and required staff to carry out all personal care tasks including feeding. Staff also feed two of the residents who were sitting in the lounge. It took staff approximately 2 hours to feed everyone at lunchtime and give them drinks. Staff attended to people as best they could, but they were very busy as they attempted to give everyone drinks, carry out positional changes for people in bed and spend some time chatting to residents. Residents and relatives did tell us that staff were kind to them when carrying out care tasks. A relative said staff always responded well to requests and on the whole they were happy with the staff attitude. We talked to staff who told us that they had enough equipment to carry out their tasks. They said if they needed anything it was quickly provided. We found a tablet on one of the dining tables that had not been cleaned since being used for breakfast. We handed this to the regional manager for the company, who was visiting on the day of the inspection. At the random inspection carried out by a pharmacist inspector in October 2009 a requirement was made that the home must ensure that the policies and procedures for managing medication must be adhered to. Recommendations were also made to improve practice. We looked at a sample of medication records and found evidence thst the good practice recommendations had been adopted. However an internal audit, carried out at the time of the inspection, found that the full audit trail was incomplete due to medication not being recorded as received into the home. Care Homes for Older People Page 14 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home places due emphasis on social care needs of service users but there is not enough attention to the detail of service users experiences. Mealtimes could be better arranged for some service users. Evidence: SOCIAL CONTACT AND ACTIVITY The visitors book was examined and it indicates that there is an open visiting policy. The homes assessment and service user plans includes the social needs of service users. Service user plans include regular entries to do with the social activity and engagement with service users. The home has employed an activity organiser. The organiser was accompanying the vicar to meet with individual service users. The organiser said that she has introduced regular social events, such as coffee mornings and singers as well as day to day activities such as use of floor games, quoits, crafts. A PAT Dog attends weekly. She has encouraged one to one activity, such as service users helping with daily tasks; for example - dusting. There was evidence in the daily records in service user plans that Care Homes for Older People Page 15 of 33 Evidence: these things were happening and staff were evaluating how well these things worked for service users in the record. Some service users were taken out in the minibus during the inspection. The hairdresser was also attending the home. A high level of visitors were coming and going throughout the day and staff were responding quickly to any requests they and the hairdresser made.The lounge in the mixed gender dementia unit is not big enough to seat everyone and their visitors. Two armchairs are located just outside the lounge near the lift, and these were used. At times the lounge was very busy and felt overcrowded. The manager said that he has plans to turn the staff rest room into an alternative lounge/activity area. One of the dining rooms was being used for a brief staff training session. Service users were seen to walk around freely and with assistance as they wished. One service user was accompanied around the unit by a visitor. Some service users did not leave their rooms, and the activity organiser and the vicar spent time with these people also. Mid morning drinks are served from a trolley to where people are seated at the time, and ,where people need these ,special cups are reserved for service users. Mostly this worked but for one person it was quite difficult for the staff supporting the service user to reach across , as there was no room to sit beside the person and this had a detrimental affect on how well the staff could keep pace with the drinking speed of the service user. This was observed during the SOFI observation. We also saw that staff make frequent good interaction with service users as they carry out other tasks in the communal areas, though many of these are directed at service users who are already engaged with others. Some people sit for long periods in a withdrawn state. The Deputy Manager has received specialised training in observing care. This is called dementia care mapping and is a very valuable resource for this kind of service. The Deputy Manager has carried out one observation of her own and we discussed this with her. She told us that some of her findings have been included in the care plans. Links should be made form these findings to the role and responsibilities of the actvity organiser. Especially for those people who cannot participate fully in group activity. A relative had made a complaint about the staining of the cups. In the written response the manager had given a commitment to replacing these with new melamine cups. These were not available yet in the home. FOOD. An inspector sampled the food at lunchtime, it was soup and sandwiches Care Homes for Older People Page 16 of 33 Evidence: followed by crumble and custard. The food tasted good enough though the presentation was basic. The cook was preparing their evening meal, there were two vegetables boiling at 1:30 in the afternoon for the tea at five oclock. Both vegetables were frozen, though one fresh vegetable is usually used. Staff helped residents to eat in a sympathetic manner, they sat beside people and gave them enough time to finish their meal. Biscuits were served but these were very hard. Staff commented on this to the kitchen staff. On the first day an inspector observed a meal being taken by men from the all male unit. There is no dining room in this unit. The staff said that service users are asked if they would like to come along to the ground floor dining room, but most prefer to stay on the unit. Only three men came to the dining room for the evening meal. The table was set nicely with a cloth and napkins and the staff made sure that service users received salt and pepper and could manage the meal with the cutlery available. The staff from the unit stayed with them and supported people in a sensitive and respectful manner. Service users were given choices and their pace of eating was respected. The staff sat with the service users and made a social occasion of the mealtime. They were the only people using the room for this meal. A hatch in the wall was open and food was served directly from the adjacent kitchen through this. The radio was on in the kitchen and the kitchen staff were talking above the sound of this. One could also hear the general noise of kitchen work being undertaken. The manager commented that this room was rather noisy. On the second day an inspector visited the male unit at breakfast time. One person was being fed cereal in the lounge in an easy chair at a side table. The staff was seated properly, and fully engaged with the task. The armchairs in this room are marked with what look like food and drink stains. On the second day of the visit there was a mix up with the main meal second course. Ice cream was served and this had been served the previous day. The temporary cook thought that this was because some stocks had not been ordered or had not turned up the previous day. This was his first day so he was not sure about this. When asked about the menus and special diets he was not sure as he was not a regular staff member. On the second day we observed service users being assisted with meals in the general unit and the dementia care unit dining areas; again staff were fully engaged with the task, appropriately seated and respectful of the time required for service user to eat each mouthful. Also staff were observed to be kindly encouraging and, talking to service users about the food and their enjoyment of it. There are food charts in service user plans for people who need these but some of the food charts were incomplete. Care Homes for Older People Page 17 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and their representaives receive inconsistent quality of repsonses to concerns. Evidence: The complaints procedure in the service user guide does not match the procedure in the complaints file, and some contact details are out of date. The current procedures should each mirror the up to date information and processes, so that staff and service user have the same expectations of what should happen. The file includes evidence that complaints have been investigtated by Bob Nelson. The formal follow up and outcome is described in letters to complainants. One member of staff and one service users relatives said that they did not feel that their concerns were taken seriously by the manager. The relative said that she thought it was to do with the fact that she had previously worked at the service, the staff said that she felt that the manager did not see her point of view and did not care. Two friends of a service user on the male unit said that the home was marvellous, there had been no problems since their friend came to live there and that the staff would do anything for them if they reaised things. The home has written safeguarding procedures and processes. However, staff are not up to date with safeguarding training. Since the last inspection of the home three Care Homes for Older People Page 18 of 33 Evidence: referrals have been made under the arrangments for safeguarding vulnerable adults. One of these has been resolved, one is resolved in part and one is still under process of investigation. The Care Trust safeguarding team will be holding further planning meetings with the service in the future. The home has co -operated with these processes. It is the view of the safeguarding team and the inspector that had there not been a delay in addressing concerns at the time they were made, safeguarding processes may not have been required. Care Homes for Older People Page 19 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the home provides a pleasing environment but attention to detail of cleaning and the availability of adapted services would improve service users choices and experiences. Evidence: The home has safe level pathways at the main entrance. There are secure access arrangements with clear procedures for visitors to sign in and out of the building. The grounds are safe and well maintained. There is evidence that the handyman takes responsibility for routine safety checks, security checks and general ongoing maintenance. There was no evidence of any immediate safety hazards during the tour of the building. Upon entering, the home appears to provide an attractive and comfortable living environment. It is well lit throughout and attractively decorated. There is evidence that recent efforts have been made in the mixed gender dementia unit to make main corridors more attractive with pictures, photographs and textured hangings. The home is divided into three units. A general nursing unit of 10 beds. A mixed gender unit, and an all male unit; both for people who have dementia. Each unit has its own communal facilities. But the male unit does not have a dining room. This means that service users from this unit come to the adjacent unit dining room for Care Homes for Older People Page 20 of 33 Evidence: meals, if they wish to do so. The staff from this unit said that most people choose to remain on the unit for meals. On the day of the visit three gentlemen came to the dining room for their main meal of the day. The mixed gender dementia unit has one main lounge and this has a rather overcrowded feel when all the seats are occupied. The furnishings are generally of good quality, though two armchairs on the dementia unit corridor were badly stained and one of these had no seat cushion. Service users attempted to sit on this chair when unable to find a seat in the lounge. The manager said that he intends to change the staff rest room on this unit as a second lounge or activity room. The lift in the main building has narrow access. This makes it difficult for staff with service users who are sitting in a wheelchair to steer into the lift safely. One person had a toe bumped on the doorway during this maneuver. Neither the service user nor the person wheeling the chair appeared to notice this. This was reported to the deputy so that the service user could be checked over for injury. There is no hazard notice by the lift door to highlight this risk. The manager should carry out a risk assessment for the use of the lift and put in place measures to reduce the risk of accidents or injuries to people. On the all male unit floor coverings are washable throughout, giving a more institutional feel, though it is appropriate for the needs of the service users and in the interests of good hygiene. The paintwork on some of the doors in this unit is damaged and in need of refreshing. Some of the chairs in the lounge are marked with what appear to be food and drink stains on the arms. The home was odour free throughout the communal areas and corridors and generally well kept. But it was noticed that the wall in the bathroom on the mixed unit was marked with faeces, there was no hand-wash in this room and the bath had hairs in it. The separate toilet on this unit was not clean. The toilet bowl was marked and the wall behind the wash hand basin was marked badly with splash stains. The pedal bin in this room had used pads in it. There was no clinical waste bin. Some of the tiles were cracked in the shower room and the shower fitting, shower head and soap dish were grubby. The toilet lacked grab rails and the bath in the bathroom was out of use. Staff said that this was because the bath seat did not have a lap strap. Because the bath was out of use any person on the unit who preferred a bath would need to go to another unit for this. In the dining room on this unit two of the tables were covered in dried food from breakfast. The floor and walls had food deposits on them. The mantelpiece over the fireplace was stained with old dried ring marks from cups. Two cleaners were on duty Care Homes for Older People Page 21 of 33 Evidence: for the entire home. One of the cleaners, when asked, said that she felt the home required more cleaning hours to keep on top of the work. The floor in one of the bedrooms on the male unit had a puddle of urine on it and the service user was still sleeping in bed. A general assistant was attending to cleaning on this unit. The home has a laundry room that is sited so as to avoid laundry crossing food areas. The home has had problems with the laundry facility in the past and as a result brand new commercial machines with sluice and disinfection facilities were fitted in 2009. The laundry assistant confirmed that the equipment was working and that she had the resources she needed including sufficient bed linens and towels to keep clean stocks available. There is a shortage of tablecloths and the laundry assistant had reported this but was not sure when these were coming. The laundry assistant said that she was not happy with the layout, space available in which to work and the arrangements for storing dirty linens from the night shift, which result in her being expected to pull these in from the shed each morning. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited carefully and generally feel supported but there are areas where staff feel vulnerable and training has fallen behind schedule. Evidence: The manager said that the required staffing level for the current needs of service users is: Four First Level Nurses through the day. Eight carers throughout the day. Two nurses and four carers at night. When we arrived at the home the manager informed us that there were only three nurses on duty. One of these was a bank nurse who was familiar with the home. There had not been any attempt made to find an agency nurse and provide four nurses. The manager stated there were a number of vacant posts for nurses within the home, recruitment is ongoing. When we observed the care throughout the home we concluded that the staffing levels were not sufficient to meet the needs of the individuals living within the home. This was because parts of the home were not clean. One care staff was told to move from duty on the male unit to the mixed gender unit by the nurse in charge of the shift as cover was not available on that unit. The staff said that she did not feel as confident to Care Homes for Older People Page 23 of 33 Evidence: work on that unit. Staff on the general nursing unit were very busy. Five service users were being cared for in bed and all these people needed to be fed by the carers. Two ladies sitting in the lounge on this unit also needed to be fed. The feeding process took two hours and staff were taking their time to feed people in a sensitive way in accordance with good practice. Staffing levels should be reviewed taking account of the dependency of the current residents. Staff training records indicated that most, but not all, of the statutory training was up to date. There is a training overview which is held electronically, however, it was not up to date and some of the vocational training was not reflected. There should be a system in place to ensure that staff do not fall behind with mandatory training. Five staff recruitment files were checked. They contained application forms, two references, evidence of identity and good background checks. All staff were interviewed and interview records were available on the files. Staff had received job descriptions and terms and conditions of employment. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a registered manager and a deputy but there is evidence that the internal quality assurance processes are not working as they should be. Staff supervision is not up to date. The home has strong administrative and safety processes that protect service users interests. Evidence: Most of the staff told us that they felt supported by the manager. They said that he listened to them and help them to access the skills and equipment they needed to carry out their job. One staff member and one relative said that they felt their concerns and comments were not valued. Staff told us that the staff teams had recently been reorganised and they now worked more consistently on one floor. Staff believe that this helps them to provide consistent care to residents. A staff member who was told to work on another unit for the day was not happy about this and said that she was not confident about moving form the unit on which she was trained to work. Care Homes for Older People Page 25 of 33 Evidence: Staff, residents and relatives had been consulted through meetings but these are not happening regularly enough. Meetings have been held approximately every six months. There was evidence of self monitoring and audit, which, had they been carried out correctly, should have prevented most of the issues raised in this report. The manager completes a home risk monitor report weekly which is sent to the Provider. The Providers representative should visit the home monthly to carry out Regulation 26 monitoring visits. The records of these should be available for inspection, however, there were only records for April, June and July 2009. Records showed that staff were not formally supervised on a regular basis. The manager confirmed that this was correct and he is addressing this through a system of a delegated supervision programme. One of the staff told us that they did not feel confident enough to carry out supervision for other staff and they would like training in this area. The records show that there are robust procedures for maintenance and safety of the building and security of service users monies. Care Homes for Older People Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 Best practice guidance and 29/12/2009 the providers medicines policy must be followed when storing, giving, recording and disposing of medicines. To protect people from the risk of medication error or omission. Care Homes for Older People Page 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Action must be taken to ensure that care staff have the training and information necassary to be able to adjust the settings for pressure relieving equipment. This will protect the skin integrity for service users who are at risk of pressure sores. 31/03/2010 2 7 15 Action must be taken to 30/04/2010 ensure all service user plans are reviewed, evaluated and updated to reflect the current care needs of service users. This will ensure that the health care needs of service users are consistently met and safeguard their well being. 3 20 23 Soiled and damaged furniture must be cleaned, repaired or replaced. 30/04/2010 Care Homes for Older People Page 28 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that the dignity and safety of service users is maintained. 4 20 23 A full review of the use of the communal areas must be undertaken to ensure that there is sufficient seating in the dementia unit and there are satisfactory arrangements in place for people dining in the all male unit. This will ensure the comfort and well being of all service users. 5 22 23 The bath chair on the dementia unit must be repaired and a grab rail provided in the toilet on this unit. This will ensure that people are able to have access to safe toilet and bathing facilities on this unit. 6 26 23 The registered person must ensure that all areas of the home are kept clean at all times. This will ensure service users live in a safe and hygienic environment. 30/04/2010 30/04/2010 30/04/2010 Care Homes for Older People Page 29 of 33 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 7 26 13 Hand wash facilities must be 30/03/2010 provided in all bathrooms and toilets. Clinical waste bins must be available in bathrooms and toilets. This will ensure the safety, health and well being of service users. 8 27 18 Staffing levels must be maintained at the level that the service has identified. This will ensure consisteny of care and quality of food provision for service users. 30/04/2010 9 30 18 Action must be taken to ensure staff training is brought up to date. This will ensure service users receive the appropraite care and are protected form harm. 30/05/2010 10 33 24 The homes quality assurance must be adhered to and take into account individual and collective needs and wishes of service users and other stakeholders and act upon these. This will ensure service users receive a consistently high quality service. 30/04/2010 Care Homes for Older People Page 30 of 33 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 11 37 17 Records held at the home must be kept up to date. These include records relating to service users and those relating to staff training. This will ensure that accurate records are maintained at all times. 30/04/2010 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 1 The service user guide should be updated to include relevant details of the Care Quality Commission and to more clearly describe the complaints procedure, line of accountability and the staffing of the home. More appropriate equipment to protect service users from scratch injury should be provided, in order to preserve their dignity. The social needs of service users who are not able to communicate easily and join in organised activity should be considered and planned for by use of dementia care mapping process. Attention should be given to evaluating the quality of mealtime experience for service users who live on the male unit, including the experience of those who come to the dining room and for those people who choose to stay on the unit. Consideration should be given to alternative welcoming ways of gathering suggestions, concerns and ideas for improving the service. The role of the deputy manager should be clearly described in the service user guide. 2 10 3 12 4 15 5 16 6 31 Care Homes for Older People Page 31 of 33 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 7 36 Staff supervision meetings should be brought up to date. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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