Inspection on 06/01/10 for Chasewood Lodge

This inspection was carried out on 6th January 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chasewood Lodge 23/03/10

Chasewood Lodge 17/01/09

Chasewood Lodge 12/12/07

Chasewood Lodge 23/11/06

Chasewood Lodge 13/04/06

Chasewood Lodge 02/02/06

Chasewood Lodge 09/06/05

Chasewood Lodge 04/10/04

Chasewood Lodge 18/05/04

Similar services:

Coton Hill House

Doddington Lodge

Far Croft

Churchill House Nursing and Residential Home

Field Farm House

Church Terrace Nursing & Residential Home

Fountain Court

The Forbury

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Chasewood Lodge Mcdonnell Drive Exhall Coventry West Midlands CV7 9GE     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julie McGarry     Date: 0 7 0 1 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 34 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 34 Information about the care home Name of care home: Address: Chasewood Lodge Mcdonnell Drive Exhall Coventry West Midlands CV7 9GE 02476644320 02476645866 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Chasewood Care Ltd care home 107 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated 107 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 12 Dementia over 65 years of age (DE) 95 Date of last inspection Brief description of the care home Chasewood Lodge Care Home is a registered care home, providing care to older men and women with a diagnosis of dementia, with a facility to take younger adults with early onset dementia. The home is situated in a cul-de-sac and lies next to the M6 with easy access to Nuneaton, Coventry and Bedworth. There are local shops, which are accessible and the nearest town is Bedworth. There is local bus service to the home. The home is registered to provide care for a 107 people. Ninety-five beds are registered for older people with dementia and 12 beds for younger adults with early onset dementia. The old and new buildings are linked. The home provides unitised care in both the new and old buildings; each unit has separate lounge, dining, assisted Care Homes for Older People Page 4 of 34 Over 65 95 12 Brief description of the care home bathrooms and toilet facilities. Residents are free to walk around the building and use facilities on any of the units. Throughout the home there are also additional quiet communal areas and a hairdressing salon is located on the ground floor. The service has now has a spiritual room and gym facility at the home. Information about the home is available in a document entitled Information book and this contains information and photographs of both Chasewood Lodge and the new home known as Chasewood Manor. There are parking facilities at the front of the building, and further spaces at the entrances to both the new and old buildings. The manager has advised that the current fees for a place in the home is between £420.16 and £435.16 per week for dementia care for people over 65 years. Weekly fees for younger adults with dementia start from £500. Other additional charges include the hairdresser, chiropody, personal toiletries, newspapers and magazines. The fee information given applied at the time of the inspection; persons may wish to obtain more up to date information from the service. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is zero star; this means that people using the service receive poor outcomes. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at key aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. We carried out this unannounced key inspection over two days. As the inspection was unannounced the registered owner, manager and staff did not know we were going. A Pharmacy Inspector was also involved in the inspection; she carried out a full inspection of the medication management systems and safety. Before the inspection we looked at all the information we have about this service such Care Homes for Older People Page 6 of 34 as information about concerns, complaints or allegations; incidents; previous inspections and reports. Registered care services are required to complete an Annual Quality Assurance Assessment (AQAA). The AQAA provides information about the home and its development. This form was completed by the manager and returned to us within the required timescales. Seven people at the home completed questionnaires as part of the inspection process and five relatives also returned a questionnaire giving their views of the home. Eight staff and two social / health care professionals completed and returned questionnaires. At this key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Some time was spent sitting with residents in the lounge watching to see how residents were supported and looked after. These observations were used alongside other information collected to find out about the care they get from staff. We also looked at the environment and facilities provided and checked records such as care plans and risk assessments. We conducted a short observational exercise (SOFI) in the lounge of the Lodge, when we observed reactions from a group of people and observed interactions between them and staff. These observations were used alongside other information gathered to assess the quality of care. There were 68 people in residence on the day of our inspection. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information plus our own observations during our visit. Throughout this report, the Care Quality Commission will be referred to as us or we. At the end of the visit we discussed our preliminary findings with the manager of Chasewood Lodge. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Further improvements need to be made in the management of peoples medication to ensure storage in compliance with product license to maintain their stability and ensure sufficient supplies to ensure medication is administered as prescribed. The home must ensure that all areas of risk are identified, and appropriate plans in place to minimise any risk. This relates specifically to behaviour management and use Care Homes for Older People Page 8 of 34 of bed rails. This will ensure the appropriate safeguards and actions to support and protect rights and wellbeing of people. Care plans for the people at the home could be improved to demonstrate a person centred approach to care planning. Person centred care ensures people who use the service are at the centre of their care treatment and support by staff should be carried out whilst ensuring that everything that is done is based on what is important to that person from their own perspective. The management needs to ensure that all documents requested for the purpose of inspection are made available on request and open to inspection. Comments made by relatives of people who live at the home include: Provide better bedding, there never seems to be enough pillows, quilts dont seem thick enough for the winter. Keep the drawers and wardrobes tidier, X has been wearing someone elses clothes. Changed GP without telling us, new drugs we were not told about. Tracking clothes, X is often not wearing her own clothes. 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 34 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 34 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 moving into the home benefit from having their care needs assessed before admission so that they can be sure the home can meet their needs. People and their families are provided with information and visit the service prior to admission to enable them to make an informed choice. The home does not offer intermediate care. Evidence: The AQAA completed by the manager tells us We give all prospective an information booklet and statement of purpose, so that they are able to make their own choice of home. We always do a pre-assessment on service users to make sure we are able to meet their needs. Invite them to come along and try out. To find out whether this was the case, three people were case tracked during this inspection. This involved looking at their care files talking to them and their family Care Homes for Older People Page 11 of 34 Evidence: where possible, and talking to the staff that care for them. Their living accommodation and the facilities available to them were also looked at. People who are considering moving in have access to copies of the information booklet and Statement of Purpose. Both documents are informative. The care files of the two recently admitted people to the home were reviewed to identify whether appropriate pre-admission processes take place at Chasewood Lodge. Both files seen contained the standardised documentation used during the preadmission process. All assessments were undertaken by the manager. Information obtained during the pre-admission assessment were detailed. Assessments provided details of their health and personal care needs which include information on physical and mental health history, mobility, nutrition, communication and activities. The availability of this information helps to ensure that the specific care needs of each person can be identified and used to help complete a plan of care. Records on peoples files show that information was received from health and social care professionals as well as individuals relatives prior to people moving in. Where possible records of peoples own wishes about their prospective move to the home have been recorded. The home does not offer intermediate care. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated respectfully, but cannot be confident that their care needs will be met. Poor medication management fails to safeguard people who use the service. Evidence: The AQAA completed by the manager tells us Everything is documented in individuals care plans, and these have greatly improved over the last twelve months. To find out whether this was the case three people were case tracked during this inspection. This involved looking at their care files talking to them and their family where possible and talking to the staff that care for them. Thirteen peoples medication records were looked at by a pharmacy inspector. People at the home were seen to rise at their own pace and receive unhurried support and to eat their breakfast of choice. Everyone was well groomed and dressed in appropriate good quality clothing indicating they are supported to maintain a good self Care Homes for Older People Page 13 of 34 Evidence: image. Three peoples care plans were looked at. Although the care files covered all the main areas of care including significant risks were found. Entries in peoples health records show that they are being supported to attend health care appointments to monitor and treat diagnosed health needs. Peoples records show that they are being supported to attend routine health appointments such as annual health checks, dental check ups, chiropody support and eye tests. There is evidence to show that improvements have been made to identify and minimise risks to the health or well being of people living in the home. For example, one person case tracked requires support in management of pressure care. Staff were able to tell us about this persons needs and the involvement of district nursing to help heal a pressure sore. Records were seen to show staff are monitoring this individuals skin integrity and ensuring two hourly change of their position in bed. However, the care plan for this person does not reflect the level of care being provided to this individual. The plan does not tell staff about the need for pressure relieving equipment, support to be moved on a two hourly basis, appropriate use of toiletries, or the application of cream to maintain skin integrity. This lack of recording may result in inconsistent care being provided. Shortfalls in peoples care plans and risk assessments with recordings were found. For example, one professional social care assessment states X displayed some aggression resulting in verbally and physically challenging behaviours, a risk assessment is to be in place. One daily record entry at the home states X has been agitated this afternoon put them self on the floor a few times and hit his head deliberately. Staff spoken to informed of different occasions when a change in behaviour is noted. The care plan at the home states staff need to monitor and report any concerns, staff to reassure and sit and talk to X but there was no written guidance for staff about how to manage this persons behaviour, thereby helping staff to know how to handle the situation in an appropriate and consistent way. Discussion with four members of staff showed that each has a different approach to supporting this individual. None of the files we looked at contained a life history or life story for the resident. This would provide useful information which gives staff an insight into the person, their life, likes, and dislikes. It can also be used to initiate conversations between staff and the person. The manager informs us that this is in place however documents were not provided at the inspection. Care Homes for Older People Page 14 of 34 Evidence: We saw that care plans are not written from the point of view of the person using the service. A more person centred approach to care planning would help remind staff about the way the person would wish to be treated and how they would like their care to be delivered. The manager informs us that all care plans are currently being reviewed and where appropriate updated to reflect peoples needs and consideration to a person centred approach to care planning will be considered. Risk assessments are not consistently completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks. For example, at the last inspection the home were required to have risk assessment plans for the need and use of bed rails. The requirement has not been met at this inspection. Conversations with senior care staff showed a lack of understanding into the need for the risk assessment or how to write bed rail risk assessments. On the second day a template for the assessment and use of bed rails was devised by the home. After the inspection, the home provided us with a copy of an assessment by a district nurse for one individual with bed rails, however no supporting evidence was provide to demonstrate risk assessments have been carried for other people who have bed rails in place. Staff spoken with were knowledgeable about the people in their care but the lack of documented information describing their care needs means that there is a risk of inconsistent care being delivered to people living in the home. Records in three peoples care plans are dated and signed by staff to show when they were last reviewed or amended. There is no evidence that families have been involved in the reviewing of their relatives care plans. There were no written records to tell us if families who were not involved had declined. During the inspection it was noted that all people living at this service are treated with respect and dignity. Personal care was carried out in privacy and all those seen were appropriately dressed in clean clothes and looked comfortable and neat. Each person was able to spend time where they choose and during our observations of working practice, it was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind, caring and generally attentive towards them. The pharmacist inspection lasted five hours. Thirteen peoples medicines were looked at together with their Medicine Administration Record (MAR) chart and care plans. Five care assistants were spoken with and all feedback was given to the manager and owner. Care Homes for Older People Page 15 of 34 Evidence: The medication was kept in a separate medication room on each unit. Due to the adverse cold weather conditions outside, the heating had been increased to ensure that the home was warm. This resulted in each medication room being too hot to safely store medicines within. Some rooms were as hot as 29C. All medicines should be stored below 25C to maintain their stability. Controlled drugs were kept in dedicated cabinets. The lock on one controlled drug cabinet had been removed and a new lock had been attached to the cabinet. This meant that it no longer complied with current regulations. A second CD cabinet did not comply with current regulations. Medication refrigerators were available for the storage of medicines requiring refrigeration but two medicines were found in the trolley when they should have been stored in the refrigerator. This may have compromised their stability and so not work as intended. All the medicines had been checked into the home using a copy of the original prescription and the quantity received recorded. This enabled audits to be undertaken to demonstrate whether the medicines had been administered correctly and records reflected practice. The staff did not routinely check new peoples medicines with their doctor to confirm their current medicine regime. Concern was raised that one person had been prescribed medicines from the hospital and then the family bought an additional medicine that was for the same clinical condition. Staff did not check this with the doctor to see if they were still prescribed this medicine. In addition they did not know what both medicines were for and were administering both. The doctor was immediately contacted during the inspection and he was to liaise with the hospital to see which medicine was to be administered. Had staff followed correct procedures and contacted the doctor once the new supply had been bought in this would have been identified earlier Medicines dispensed in a monitored dosage system (where one dose is dispensed in one blister per day) were administered as prescribed and records generally reflected practice. Mistakes were found when the medicines had been administered from traditional boxes and bottles. Medicines had been signed as administered when they had not been. Incorrect codes for non administration were also seen. Concern was raised when two different people currently prescribed warfarin did not have this administered as prescribed. This was due in one instance to poor and misleading directions hand written on the MAR chart. This is of serious concern. People prescribed liquid medicines did not have them administered as prescribed and often the dose had not been administered even though staff had signed that they had administered them. Care Homes for Older People Page 16 of 34 Evidence: This was seen also for inhalers. Again staff had recorded they had administered them when they had not. Medicines administered by external healthcare professionals had not been recorded on the MAR chart but recorded under the visits report in the care plans and daily records. This record was either incomplete, as three days of visits had not been recorded or the district nurse had not visited or staff had failed to act. Had staff had a better system of recording medicines administered by external healthcare professionals this would have been recognised and acted upon. Controlled drugs administration were recorded in the CD register in line with current regulations but staff had not signed the MAR chart to record the administration in one instance. Whilst it was clear from the balance of the controlled drug counted in the cabinet that they had been administered correctly staff should ensure that all records are complete. Some staff spoken with had a good understanding of the medicines they handle. Two care assistants spoken with though did not and had a very poor understanding of what the medicines were for. They would not and did not in one instance reported, be able to fully support the clinical conditions of the people they looked after. Concern was raised that eight out of the twelve people that lived in the old unit were prescribed sedating medicines, many prescribed to give when required but were given routinely. There were no protocols detailing when they should be administered only. One medicine had been routinely administered at twice the maximum dose prescribed. This level of use of sedating medicines was not though seen in any of the other units. Care plans lacked important information about the clinical conditions of the people in the home so it would be difficult for new staff to understand their needs. The manager used to regularly assess staff competence in the safe handling of medicines but has not done so for a while. She was unaware of the problems found during the inspection and agreed to reinstall the quality assurance system to improve the medicine management in the home. Care Homes for Older People Page 17 of 34 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 benefit from a nutritious and varied diet and have access to a range of activities that take into account their needs and preferences Evidence: The AQAA states daily living activities to encourage staff to grasp each opportunity with each service user. Encourage families, friends and relatives to visit regularly and remain involved. To find out if this was the case, a discussion was held with the manager, staff, people who use the service and visitors to the home regarding recreational activities on offer. A lunchtime and evening meal were observed. The overall atmosphere in the home was friendly and relaxed. We spoke to a visitor to the home who told us that they were able to visit at any time and were made welcome. People are encouraged to maintain links with their family friends and the local community. Representatives from the local churches visit weekly / monthly. We conducted a short observational exercise in the main lounge, when we observed reactions from a group of people and observed interactions between them and staff. Care Homes for Older People Page 18 of 34 Evidence: We saw that staff were kind in their approaches to people. We also observed that staff were good at offering choices and supporting people in decision-making, for example asking people what they want to eat and drink for their evening tea. There is a program of activities at the home which includes outing to Warwick park, trips to garden centres, annual fete, Bedworth Civic Hall matinee performance, fortnightly fizzal fun, and Church services. However for the three peoples records we looked at there was little information recorded, for example staff had sometimes simply recorded chat as an activity but does not detail what they chatted about, for how long and if the person had enjoyed the chat. It was therefore difficult to know whether they had participated in any activities in the home. There was no information about their interests or preferences for how they spent their time. Also there was no information about their life history. At lunchtime people in the home were seen to enjoy their meal which was served from a hot trolley in the dining room. Good sized portions were given and the meals looked hot and appetising. The cook explained that the home also provides for cultural needs as well as specialist dietary needs. These included alternative meals such as curry and food items with reduced sugar. Good practice at meals time was observed for people who require liquidised diets. The cook ensures food portions are liquidised separately to maintain the colour and appearance of the foods where possible. Meals times are staggered in each unit to ensure food is provided at suitable temperatures. A member of kitchen staff accompanied the hot trolley around the home to assist care staff. Staff were seen to assist people where necessary. One to one support was offered to people who remained in their beds during meal times. There were positive comments made about the food, such as very nice, you get a lot. During discussion with staff, we were told that the home provides good meals for residents, activities and good entertainments, however this was not the view of all staff, as some felt more activities were needed including trips out. Care Homes for Older People Page 19 of 34 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. People would be better protected by staff who have received up to date training in the protection of vulnerable adults. Evidence: The AQAA states We look on complaints as a constructive criticism and try and resolve them within 28 days. We ensure that the appropriate paperwork is completed and sent to The Care Quality Commission unless it is safeguarding which is longer. To find out if this is the case, we requested the concerns, complaints and compliments folder, looked at staff records and talked to staff about complaints and safeguarding the people who live there. The home has a complaints policy, however this is not displayed in the home for the benefit of the people who use the service or visitors. An accessible complaints procedure is available in the homes information booklet. The manager said that there has been one complaint made to the home since the last inspection, one year ago. This was verified in the complaints folder. Staff were seen to be attentive to the needs of the individuals, using knowledge gained from other professionals, the homes care plans, and their own experience of working with each person. We observed staff taking time to listen and observe signs Care Homes for Older People Page 20 of 34 Evidence: and cues to ensure they understood peoples views. Individuals who live at the home appeared relaxed with staff which may indicate that they feel safe. According to information received on the AQAA, the home has policies and procedures regarding adult protection and whistle blowing. Four staff spoken with demonstrated a basic understanding of the types of abuse they might encounter and to whom they should report any concerns. All four members of staff did not consistently recognize abuse when different scenarios were presented to them. The training matrix shows that not all staff have completed training in the protection of vulnerable adults. This may lead to incidents of abuse not being reported in line with local multi agency approaches to safeguarding vulnerable adults. Over the past twelve months, four referrals have been made by the home to the local safeguarding adults team about concerns which have arisen regarding people who live at the home. We have received information from ex staff and health professionals that have been looked at under the local authority safeguarding procedures. Peoples money is held in safekeeping by the home. Three peoples records were checked. Each transaction is being signed by staff as verification of money passed to people or spent on their behalf. Receipts are not always being kept as further evidence of money spent. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and clean home that allows them to move around freely. Evidence: The AQAA states We have designed the home to specifically meet the needs of service users. We ensure that the home is homely, warm and welcoming. We encourage the services users to bring personal items for familiarity. A well maintained outside environment. To find out whether this was the case, the living accommodation and the facilities available to people who live at the home were looked at, records viewed and spoke with people who live there. At the time of this inspection there were 68 people living at this home that can accommodate 107 people. All bedrooms seen were clean and had been personalised with pictures and ornaments. People who live at this home are able to have a telephone in their room for their own personal use. Three people spoken to state that they were happy with their rooms and that they are kept clean and tidy by staff. The home has three sections, the older part of the building, which is a converted large Care Homes for Older People Page 22 of 34 Evidence: family residence, a new building over two floors for older people with dementia. This area is purpose built and is divided into small units of 12 to 13 people in each area. The final area is 12 beds divided into three 4 bedded units for younger people with dementia. All the areas were seen to be clean and tidy and free from unpleasant smells. People were seen pottering freely around inside the home between the units. Domestic staff were spoken with and told us that they have enough time and are supplied with all materials to ensure that the home remains clean. Care staff ensured that the small dining areas and lounges remained comfortable and inviting during the day. The laundry is done on the premises and this is managed well ensuring that cross infection is minimised. The kitchen is located in the older part of the building and meals are staggered to ensure that each unit receives fresh hot food, which is delivered using a heated trolley. The kitchen was clean however records requested for inspection from the kitchen were not made available when requested. Care Homes for Older People Page 23 of 34 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. People cannot be confident that staff have all the skills, knowledge and experience to meet their needs. Evidence: When asked what the home does well, the manager responded in the AQAA maintain our current quality of staffing levels and training levels. To check that this is the case, we looked at three staff files, spoke with staff and the manager. Three weeks staffing rotas were seen. Each unit has a senior member of staff during the day shifts and two carer staff to ensure that the needs of each person are met. There are also staff to work in the laundry, kitchens and to maintain the cleanliness of the home. A handyman is available for repairs and to ensure that maintenance checks are completed. Three staff files were looked at to check the homes recruitment procedures. All three files contained evidence to show that staff are interviewed. Files contained evidence of proper vetting procedures including two references and Criminal Record Bureau checks. This is necessary to ensure that suitable staff are employed at the home. It is not clear from the records if the home obtains a reference from previous employers. Care Homes for Older People Page 24 of 34 Evidence: Additionally, not all staff files requested were made available for the purpose of inspection. The home must ensure that all requested documents are made available at the inspection. Supervision records told us that this is not consistent for all staff. It is important that all care staff receive formal supervision at least six times a year and that this is recorded. This is to ensure people are supported by staff who have the competencies and qualities required to meet their needs. Information supplied by the manager in the AQAA states that 30 members of the 60 permanent care staff are qualified to National Vocational Qualification in Care Level two. This is at the national Minimum Standard for 50 per cent of staff to be qualified. The information in the AQAA is not consistent with records at the home. The training record shows that 20 of the 53 staff have attained this qualification. On discussion with the manager were were told that the training matrix was not up to date. The training matrix shows that not all staff have completed induction training or the core areas mandatory training. This includes training in safeguarding of vulnerable adults. In questionnaires returned by staff comments included: There probably could be more training and not left so long between training days. More communication between management, seniors and carers with passing on of new procedures. Employ more experienced staff... more senior staff at weekends. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be confident that the service is always managed in their best interests. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the service manager was completed to a poor standard. It states the manager and senior team have been in place for along time. Quality assurance system in place an audited by an outside consultant. We looked at how the home monitors the quality of the service it provides. We found that there were a number of aspects of the running of the home that needed more careful attention such as the care plans, risk assessments and the quality monitoring process. Quality assurance systems in place are limited to an annual satisfaction survey of people who use the service and relatives, with the latest survey being undertaken in January 2009. The deputy manager had analysed the results but there was no evidence that the results had been shared with people who use the service or an action plan developed to demonstrate how the home was going to act on their Care Homes for Older People Page 26 of 34 Evidence: findings. There is no evidence to support the AQAA statement that the quality assurance system in place an audited by an outside consultant. The manager had not surveyed other stakeholders, for example, GP, District Nurse or Chiropodist. There are no residents or relatives meetings. We were told that peoples views are sought at reviews, however there was no documentation of this. Further work is required to improve quality assurance systems to ensure that the people who live at Chasewood Lodge are happy with service provided. The home has not met the quality assurance requirement made at the last inspection. As identified by the pharmacy inspection, management of medication must improve to ensure they are stored and administered safely. Details of medication management is detailed in the pharmacy report in the Health and Personal Care section of this report. When requested, the manager was unable to provide us with all documentation required for the purpose of the inspection. The home must ensure that all staff are trained in, and understand, both the homes and local authority procedures for the safeguarding vulnerable adults. This will help ensure that areas of concerns and protection are addressed appropriately. There was evidence from a random check of records that equipment is regularly serviced and maintained health and safety checks are carried out. A number of checks are made by staff to make sure that peoples health and safety is maintained. Records showed that the fire alarm system had been regularly tested and serviced to make sure that it was working properly. A gas landlord certificate was seen and showed that this is due to be carried out soon. As previously noted, peoples money is held in safekeeping by the home. Three peoples records were checked. Each transaction is being signed by staff as verification of money passed to people or spent on their behalf. As previously noted, receipts should be retained in respect of any purchases made on behalf of people who use the service. This will protect the financial interests of people living at the home. Care Homes for Older People Page 27 of 34 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 7 12 Care plans must state actions to be taken to minimise risk for those individuals who have been assessed as being at risk. This will ensure that all staff are fully aware of the risks and actions to take to minimise the risk. 13/03/2009 2 8 13 A full assessment and risk assessments must be available for those people who require bed rails for safety. This is to demonstrate that bed rails are used appropriately to maintain safety and not to restrain. 13/03/2009 Care Homes for Older People Page 28 of 34 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 8 13 Strategies for effectively monitoring and dealing with any challenging behaviours and pressure care must be clearly detailed in individual care plans. This is to ensure that there is consistency in care that maintains individuals and staff safety. 12/02/2011 2 9 13 All dose regimes must be 12/02/2010 clearly written on the medicine chart, checked by a second member of staff for accuracy. This is to ensure that the staff have clear directions to follow. All medicines must be stored 12/02/2010 in compliance with their product licences. This is to ensure their stability 3 9 13 Care Homes for Older People Page 29 of 34 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 4 9 13 A system must be installed to check all new service users medication with their doctor. This is to ensure that they are administrated their current drug regime 12/02/2010 5 9 13 The medicine chart must record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records reflect practice. 12/02/2010 6 9 13 A quality assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect 12/02/2010 Care Homes for Older People Page 30 of 34 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 practice, to ensure that all medicines are administered as prescribed and this can be demonstrated. This is to ensure that individual staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that staff do not administer the medicines as prescribed. 7 18 18 The service must ensure that staff are trained in and understand safe working practices, this specifically relates to the protection of vulnerable adults. This is to ensure to health, safety and welfare of people who use this service and staff are protected. 8 32 17 Documents requested for the purpose of inspection must be made available on request and open to inspection. This is so the home can evidence what actions have been taken by the home to comply with the Care Home Regulations 2001. 12/02/2010 26/02/2010 Care Homes for Older People Page 31 of 34 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 9 It is advised that staff are trained in the indications and side effects of the medicines they handle and assessed to ensure that they do know what they are for to enable them to fully support the service users clinical needs. Records of daily activities for each person should be more detailed and describe the activity and their participation. A life history of each person living in the home should be developed so that carers understand and can talk with them about their life experiences. Wherever possible service users must be offered choice and the opportunity to exercise some control over their lives. This should be demonstrated in a person centred care plan and reviewed regularly to reflect changing needs and abilities. A copy of the complaints procedure should be made available in the home at all times and should be clearly displayed throughout the service. This will help to ensure that people who use the service, staff and visitors have a clear understanding of how to make a complaint. 50 of staff should be qualified to NVQ level two to ensure people are supported by staff who have the competencies and qualities required to meet their needs. All staff should complete the required training to provide safe care and services to the people at the home. The training schedule should be kept updated and show the dates when refresher training should be undertaken by. This will ensure that staff get their skills and knowledge updated regularly. An up to date training matrix should be maintained so people can be confident that training needs and any updates will be responded to appropriately. Systems that will effectively monitor and audit working and care practice in the home should be introduced. These procedures must be ongoing and should include obtaining the views of stakeholders regarding the quality of service at the home. Receipts should be retained in respect of any purchases made on behalf of people who use the service. This will protect the financial interests of people living at the home. 2 3 12 12 4 14 5 16 6 27 7 28 8 30 9 33 10 35 Care Homes for Older People Page 32 of 34 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 11 36 All staff should have supervision at least six time a year to help in staff development and ensure staff have the appropriate knowledge and skills to carry out their jobs. The standards of health and safety management within the home must be reviewed. This should include the recording of fridge / freezer temperatures and cooked foods. 12 38 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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