Inspection on 14/05/09 for Cheney House

This inspection was carried out on 14th May 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cheney House 08/12/08

Cheney House 28/02/08

Cheney House 05/04/07

Cheney House 06/04/06

Cheney House 11/10/05

Cheney House 20/04/05

Cheney House 16/12/04

Cheney House 01/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

Key inspection report CARE HOMES FOR OLDER PEOPLE Cheney House Rectory Lane Middleton Cheney Banbury Oxon OX17 2NZ Lead Inspector Irene Miller Key Unannounced Inspection 14th May 2009 09:00 DS0000012735.V375604.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 2 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 Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cheney House Address Rectory Lane Middleton Cheney Banbury Oxon OX17 2NZ 01295 710494 01295 712784 cheney@regalcarehomes.com www.regalhomes.com Regal Care Homes Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Manager post vacant Care Home 34 Category(ies) of Dementia - over 65 years of age (34), Old age, registration, with number not falling within any other category (34) of places Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No person falling within the category of DE(E) may be admitted into Cheney House where there are 34 service users who fall within the category of DE(E) already accommodated within the home. No person falling within the category of OP may be admitted into Cheney House where there are 34 service users who fall within the category of OP already accommodated within the home. 8th December 2008 Date of last inspection Brief Description of the Service: Cheney House is a care home providing personal care and accommodation to thirty-four older people who may have a dementia related illness. Regal Care Homes Ltd are the Registered Providers of the home. The home is located in the village of Middleton Cheney and is set within its own grounds. The building was a former rectory and is a listed building. There are nineteen single bedrooms of which nine have en-suite toilet facilities. Of the eight bedrooms, which are shared by two people, two have en-suite facilities. Middleton Cheney has amenities such as three churches, shops, post office, chemist, doctor’s surgery and three public houses. The village is on a bus route to the town of Banbury, which is approximately three miles away. The fees at the time of this inspection range between £350 to £550 per week, the fee is dependant on whether residents are funded by the local authority or by private arrangement. The service user guide gives details on the difference in fees and how they are set dependent upon the care and support required and type of bedroom facilities chosen. The fees include accommodation, personal care, meals, laundry and some activities and entertainment. Chiropody and hairdressing services can be arranged and are charged separately. Other costs would include clothing, dry cleaning, some outings and toiletries. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is One star – Adequate Service. This means the people who use this service experience adequate quality outcomes. The focus of all inspections undertaken by the Care Quality Commission are based upon seeking the outcomes for people using the service and their views of the services provided. This visit was unannounced and focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. The inspection lasted over two days and involved two regulation inspectors. The care records of people using the service were sample checked which involved looking through written information available on their care, such as their individual care plans (a care plan sets out how the home aims to meet the individual service users personal, healthcare, social and spiritual needs). During the visit people using the service were consulted on how they view the care provided at the home, and discussions with staff gave an insight into the support and training provided at the home. Observations of care practices and discussions with people using the service gave an indication on the quality of the service provided at Cheney House. A period of one hour was spent with residents who were present within the large communal lounge. During this time observations were made of the interactions between staff and residents. The time spent observing provided a snapshot of ‘life within the home’ and gave an insight as to the quality of the care provided by the staff and how the residents living at the home occupy their time. Records in relation to the homes management and administration systems, quality assurance, staffing and general policies and procedures were viewed. Prior to this visit we sent out to the provider an Annual Quality Assurance Assessment (AQAA) this document allows the provider to supply us with information on how they view their own performance, such as what they do well, what they could do better and plans for future improvements. The AQAA gave an insight into how the home is managed and quality assessed. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 6 What the service does well: Information on the aims and objectives of the home is made available to prospective people considering moving into the home in the form of the homes statement of purpose and service users guide, however these documents need to be made readily available for people to access. Within one of the care plans viewed of a person diagnosed with diabetes and at risk of hypoglycaemic attacks there was good instruction for staff on the signs and symptoms of hypoglycaemia. At the time of inspection no people using the service were receiving treatment for pressure sores, the staff are vigilant in ensuring that pressure area care is closely monitored. There were records of the frequency of turns for frail people who require to be turned whilst in bed, this is to prevent the risk of developing pressure area sores. Records of the treatment from the district were available within their care plans. During the inspection we observed the staff engaging and interacting well with people using the service and visitors who were observed to be made welcome by the staff. Care plans for people who have dementia and unable to communicate very well are reviewed with the involvement of there family/representatives. What has improved since the last inspection? Newly appointed staff are given three days induction training at the beginning of their employment, the induction covers mandatory training such as moving and handling, fire awareness, food hygiene and health and safety. The fluid intakes are monitored and recorded for people identified at risk of dehydration; this ensures the risk of dehydration is so far as possible eliminated. The personal hygiene preferences of people are recorded within the care plans such as whether a person wants to have a bath or a shower and in discussion with staff this reflected their current situation. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 7 The provider is now informing the Care Quality Commission of all significant events, such as deaths, incidents and accidents, concerns and complaints. The actions and outcomes are being recorded and information is being shared with the regulatory, health and social care bodies this demonstrates openness and transparency by the company. Assessments for the use of bedrails are in place and their use being regularly reviewed in consultation with the person and healthcare professionals involved with their care. This ensures they are used appropriately and reduces the risks of this equipment being inappropriately used. What they could do better: People moving into the home need to have a fully completed pre assessment and information from other sources such as care management needs to be included. This will ensure that care plan that is formulated from the pre assessment information identifies the range of needs of people using the service. The changing needs of people using the service must be reflected within their individual care plan and risk assessment without delay. This is to ensure that the care provided is appropriate to the individual needs of the people using the service. The blood sugar monitoring of people identified at risk of their diabetes being out of control must be carried out as directed by the general practitioner and records need to be fully legible. This is to identify and so far as possible keep blood sugar levels under control. Only under exceptional circumstances must staff take up employment without the home first obtaining clearance with the Criminal Records Bureau (CRB), in this event the new member of staff must have had a check carried out with the Protection of Vulnerable Adults (POVA) list. The member of staff must only work under strict supervisory arrangements. In this event the employer must be able to evidence the supervisory arrangements in place covering the period from when the member of staff started working at the home and the date that the CRB clearance was obtained. This is to ensure that people using the service are protected. Call bell facilities should be available in all bedrooms of people using the service and shared rooms must have a call bell facility for each occupant to access. This is so people can summon assistance when required. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 8 The fire exits at the home needs to be periodically checked to ensure that all are in working order and accessible. This is to ensure that exists routes are not obstructed by the inability to break the safety glass. And allow free passage in the event of evacuation. The homes fire log must have an up to date list of all the people using the service, indicating the location of their bedroom and mobility level. This is to ensure that in the event of an emergency evacuation the fire personnel are fully aware of each person’s mobility abilities in order to provide assistance in evacuation. The homes register must be kept up to date to include admissions, deaths, discharges and temporary discharges such as hospital admissions or holidays and be fully accessible. 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. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 People using the service experience adequate quality outcomes in this area. Failure to include important information within the pre admission assessment documentation into a care plan places people at risk of not receiving the appropriate support they require according to their assessed needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There is a statement of purpose (which sets out the aims and objectives of the home) and a service user guide (that gives details of the services provided by the home) however in discussion with the operations manager at the time of inspection we were informed that these documents were stored within the office area. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 11 The last key inspection of the home took place on 8th December 2008, within the front entrance of the home there was the front page of the inspection report from February 2008, a copy of the most recent inspection report should be made available for people using the service and their representatives. We looked at the care plan of a person recently admitted into Cheney House; an assessment which had been carried out by the placing authorities which had important information relating to the dietary needs of the person. We looked at the care plan that had been put in place and found that the dietary information had not been transferred into the care plan. Within the daily notes for the person there was entries that confirmed that the person was regularly missing their main meals and observation made over lunchtime during the inspection indicated that staff support over the mealtime was lacking for the person Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 & 10 People using the service experience adequate quality outcomes in this area. Risk assessments and associated care plans not being updated as and when peoples needs change places people at risk of their needs not being fully met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked at how the nutritional needs of one person were being met there was information within their ‘eating and drinking’ care plan on the level of support the person required, such as any specialist cutlery they may need, there was information that this person had chosen not to use any specialist eating utensils etc. There was information that the person was required to take ‘build up drinks’ due to their poor appetite, and a there was a ‘food journal’ was in place to monitor their food and fluid intake. There was records of the persons weight being monitored weekly, however this person had gained weight and the frequency of their weights being recorded had been moved to monthly. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 13 We looked at the care provided for one person identified at high risk of falls, this person had sustained several falls some of which resulted in head injuries requiring medical intervention. In discussion with staff we were informed that a falls specialist nurse had visited one of the people using the service assessed at high risk of falls, and that protective headwear had been provided. Observation made during the inspection confirmed that the person was not wearing the head protection all of the time. We looked at their care plan and falls risk assessment which had recently been reviewed and there was no instruction within either of these documents to inform that head protection equipment was in use. Instructions for staff to were to walk with the person. The person was very active and this instruction was unlikely to be followed to the letter. During the two days of the inspection the person was observed walking alone around the home on several occasions, and not always wearing the head protection. We asked staff why the person was not always wearing the head protection and comments were ‘he will only wears it if he wants to’ and ‘sometimes it is difficult to put in on him’. Instruction within the falls management care plan was unclear such as ‘will refuse to wear anything other than socks, is able to wear shoes is more stable in them’. We asked staff on duty to confirm whether the person was to wear shoes or socks (slipper style socks had been provided by their relative) the staff gave conflicting information some staff saying shoes and some saying socks. Information within the care plan and risk assessment needs to clear for all staff follow. It was noted that the person was wearing shoes with Velcro fastenings and that one of the Velcro fasteners had become loose which presented a potential tripping hazard, this was brought to the attention of the staff who took immediate action in providing an alternative pair of shoes. We looked at the records of health professional visits and there was a record of the person being seen their general practitioner who had advised the home seek specialist advice and there was reference to the persons shoes not fitting. There was a record of the person having been seen by the optician. The falls risk assessment gave instruction ‘all falls are to be recorded and all necessary body maps filled in’. We looked at records of accident reports for the person and were initially unable to locate the accident reports for the two most recent falls which had resulting in head injuries. These reports were later found in the cellar and had appeared to have been archived. Within the falls risk assessment documentation there was a body chart relating to a previous Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 14 injury sustained in January 2009, on which information of a more recent injury in had been added. The person’s relative visited during the inspection for a pre planned appointment to review the care plan, in discussion with the relative they said they are very involved with the care provided for their father saying they were very happy with the care their father is receiving at the home. It is positive that the representatives of people with dementia who have communication difficulties are included in their care plans. We looked at the care of a person with type 2 diabetes; at the previous inspection of 8th December 2008 there were concerns that their diabetes was not being appropriately managed at the home and we issued a statutory requirement instructing that ‘the blood sugar monitoring of people identified at risk of their diabetes being out of control must be carried out as directed by the general practitioner’. We received an action plan from the provider dated 20th February 2009 in which they informed us of the steps taken to address the requirement in this particular instance they stated ‘the manager to ensure that people identified as at risk with keeping their diabetes under control must be monitored as directed by the GP at all times and that records kept must be legible and accurate. If any concerns the GP to be contacted without delay’. This action was to be taken with immediate effect. We looked at the care records of this person there was instruction that the person was at risk of hypoglycaemic attacks (low blood sugar) and there was instructions for staff on the signs and symptoms of hypoglycaemia. The diabetic care plan was last reviewed at the end of April 2009; we looked at the record of blood sugar monitoring which had been reviewed at the end of April 2009. There were strict instructions on both these documents that the blood sugar level for this person was to be tested daily. There were several gaps for example a record was made on 26th February 09 that the blood sugar level was 3.6mmols, the next record was entered on 9th March 2009 with a reading of 5.4mmols. Daily blood sugar readings had not been recorded on twelve occasions up to 30th March 2009. The next record taken was on 8th April 4.6mmols then 16th April 3.8mmols. This was brought to the attention of the area manager who was present at the inspection and she confirmed verbally that the general practitioner had given verbal instruction that the blood sugar levels were no longer needed to be taken on a daily basis for this person. During the inspection the GP was contacted by telephone who confirmed verbally over the telephone to that he had visited the person towards the end of March 09 and had given this verbal instruction to staff. There was a record of the general practitioner visiting the Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 15 person on 30th March 2009, however there was no written reference to the verbal instructions that had been given. Based upon the evidenced produced at this inspection we took the decision to use our statutory powers under sections 31 and 32 of the Care Standards Act 2000 and issue a Code B notice. The reason for service of this notice was because we believed an offence may have been committed by virtue of failure to comply with a statutory requirement and seized copies of the blood sugar monitoring chart, the doctors visit record and the diabetes care plan. We believed that their may have been a breach of regulations and we issued a code B notice and seized a record of the persons diabetes care plan, their blood sugar monitoring record and the record of professional health care visits. The purpose of seizing these records was to take into consideration enforcement action. After careful consideration of the evidence gathered at this inspection we took the decision not to issue a warning letter in relation to this breach of regulation as there was sufficient evidence to demonstrate that the needs of the person in relation to their diabetic care were being met and the error was in a failure to communicate the change in the frequency of the blood sugar monitoring within the persons care records following the visit by the general practitioner. We looked at the storage and administration records of medications, there was records of medication reviews having taken place as part of the companies health and safety audits. One person was receiving their medication by method of tablets being crushed and given with foods. There was a record of family member giving consent however there was no reference as to the reason for medications to be administered this way. Care workers should not mix medicine with food or drink if the intention is to deceive someone who does not want to take the medicine. This is called ‘covert’ administration. The exception to this is when a medical practitioner states that the person lacks ‘capacity to consent to treatment’ and the medicine is essential to their health and well being. If the decision is taken to give medicine covertly, it is not good practice to crush tablets or open capsules unless a pharmacist informs you that it is safe to do so. No controlled drugs were in use at the home, however a controlled drugs storage cabinet is available should this change. We looked at the personal care needs of people and within the care plans there was information available on their personal care and bathing preferences. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 16 During the visit we spoke with a visiting district nurse, we asked their views on how the home meets the heath care needs of people. There was some concern expressed over the number of people acquiring skin tears to lower limbs and questioned whether this could be due to moving and handling techniques e.g. people catching their legs on wheelchair footplates. There was some concern that the TV always seems to be on and people not doing much in the way of activities, however they said that the staff always appear very friendly when she visits. Over recent months the home has set up monthly meetings with the district nurse team to have face to face dialogue and updates on the individual nursing care required by people using the service. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 & 15 People using the service experience adequate quality outcomes in this area. The lifestyle of people using the service could be improved by activities being person centred and available on an ongoing basis. Care taken in the presentation of pureed foods and the dining environment would improve the mealtime experiences for people using the service. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: On the first day of the inspection 14th June on first arriving at the home we observed that the TV was on in the main lounge, later that morning it was switched off and some old time music hall style of music was played, some members of staff were singing along with the people within the room, people where tapping their feet and clapping in time to the music, one member of staff was observed dancing with a person who appeared to be getting immense enjoyment out of the activity, during this time the atmosphere was lively and very interactive. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 18 On the afternoon of the 14th an outside musician came to provide musical entertainment, people using the service and relatives appeared to enjoy the entertainment and joined in with the singing. On the second day the 15th the TV remained switched on in the lounge, it was noted that the TV is in a fixed position on the wall in the main lounge. The positioning of chairs in the room made it impossible for some people using the service to view the screen and for one person was sat directly under the screen and due to their limited mobility were not able to move away from this position. A further smaller lounge is available where people can watch alternative programmes or just sit and read or relax. The TV in this room had poor reception and on further examination it was confirmed that the aerial connection was loose. This was brought to the attention of the operations manager at the time of inspection who arranged for the maintenance worker to repair the aerial connection. Within the care plans viewed each had information on the individual’s life history, place of birth, past occupations and significant events in their lives, this was recorded in written and pictorial formats. However the involvement of people in individual and group activities was poorly recorded, the home is currently without an activity person and this is having an affect on the opportunities available for people to be engaged in activities of their choice. It was observed that relatives visiting the home were made welcome by the staff and keen to give assistance with supporting their family member such as help over the mealtimes and outings. There was information within the care plans on the food preferences of people that gave details where there were difficulties with eating and drinking. In discussion with the catering staff on the second day of the inspection it was confirmed that soft and special diets, diabetic, gluten free were accommodated. We observed the quality of the presentation of a meal for one person who required a pureed diet, this meal looked unappealing. We discussed alternative ways of presenting pureed meals with the catering staff. It is important that all meals are presented in such a way that they are appealing, appetising and nutritious. On the second day of the inspection we observed people receiving their lunchtime meal it was noted that care staff did not wear any protective clothing whilst preparing people for their meal, however they were observed to wear disposable aprons whilst serving the meal. The tablecloths on the dining tables within the conservatory appeared badly creased which did not provide a pleasing dining environment. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 19 Many of the people using the service require staff assistance to eat their meals, we observed one person being fed by a member of staff who was standing up beside them. This inappropriate way of assisting people with their meal is not acceptable and we took action to ensure the person was assisted in a dignified way. This issued was also raised at the previous inspection in December 2008. It is important that the home makes every effort to ensure that the social aspects of food, its preparation, presentation and consumption remain an important part of people lives. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 People using the service experience adequate quality outcomes in this area. Improvements have been made to responding to concerns and complaints; further work is needed to provide all staff with formal training on safeguarding. This will ensure that all staff are aware of their responsibilities in protecting people. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since the last key inspection of 8th December 2008 efforts have been made by the provider to improve on listening and acting on concerns and complaints brought to the homes attention. Since the last key inspection CQC have received two complaints about the service, which due to the nature of the complaints we referred to the Northamptonshire Safeguarding Team for investigation. We also asked the provider to investigate the complaints under their own complaints procedure. We received written responses from the provider which had addressed the issues within the complaints. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 21 Information sharing meetings have taken place involving the provider, safeguarding, the commissioners and CQC. All parties have working closely with the provider to ensure that the health, safety and well being of people using the service is continually promoted and protected. Due to the lack of formal monitoring tools and recording of staff training it was difficult to establish how many of the staff team have been provided with past or recent training on safeguarding of vulnerable adults (SOVA). We looked at the homes register of admissions and discharges and it was of concern that the register had not been kept up to date; we were informed at the time of inspection that this information is also computerised. However the information was not readily available. In addition the fire log did not contain an up to date list of people living within the home, their bedrooms or their mobility levels for purpose of evacuation. The upkeep of this information is vital in protecting people using the service. In discussions with staff they had a basic understanding of the types of events that can constitute abuse, this needs to be expanded so that all staff are aware of the types of abuse that can take place and fully aware of their roles and responsibilities in following the whistle blowing and formal reporting procedures. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 People using the service experience adequate quality outcomes in this area. Repairs and refurbishment work has improved the communal areas of the home, further work is now needed to address areas within individuals living space. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A tour of the building was conducted which included viewing the communal areas, sample checking of bedrooms, the kitchen and laundry facilities. A recent health & safety audit had been undertaken by the deputy manager of the home which had identified that several call bells within bedrooms were faulty and that two bedrooms did not have call system available and within one of the shared bedrooms there was only one call bell facility available. All people Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 23 using the service must have access to a call bell facility to ensure they have appropriate support whilst they are in their bedrooms. On the 15th May 2009 the second day of the inspection an electrician was available and work was in hand to repair the faulty call bells. We found that two rooms did not have bedside lights and that in six rooms with internal bathrooms the extractor fans were not working. We were advised at the time of inspection that the installation of call bells is in hand. A requirement has been made to urgently address this issue Fire safety checks have not been routinely carried out over the past months since the inspection on 8th December 2008. However the deputy manager had arranged for these to be undertaken and records were made available of the fire checks carried out on 5th May 2009. The home is without a maintenance worker and maintenance support from another home was available on site on the second day of the inspection and they were able to make the necessary repairs to a fire door that we found was not shutting adequately. The break glass hammers to the fire exit doors were missing on all but one, this had been noted and hammers had been ordered. The latest fire drill had not been carried out on 19th May 2008. On speaking with staff they informed the inspector that there have been several occasions when people living at the home have set the fire alarms off but these had not been recorded as fire drills. Bedrails are fitted correctly and risk assessments were in place for people using them. A replacement bath hoist had been purchased and records of the servicing of lifting equipment were available. A recent accident resulted in a person using the service falling through a ground floor window which had been referred to the Health and Safety Executive for investigation under RIDDOR (Reporting of Injuries, Disease and Dangerous Occurrences Regulation. The window has been repaired and safety glass has been installed. In a letter from of the Environmental Health Officer after three visits by them in October and December 2008 they identified several maintenance issues relating to structures in the kitchen, cleaning of shower heads and hand washing facilities in parts of the home. We found that the hand washing facilities to the toilet used by staff had no hot water, but soap and paper towels were available throughout the home. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 24 The lack of hot water in the staff toilet was resolved at the time of inspection by the visiting maintenance worker. The replacement structural work has started in kitchen and we were informed that is due to be completed by the end of May 2009. We asked for CQC to be kept informed of the interim arrangements of how the catering staff are to provide meals during the refurbishment work. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 & 30 People using the service experience adequate quality outcomes in this area. Shortfalls in providing ongoing staff training and the employment of staff without CRB clearance has the potential to place people using the service at risk. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: On the first day of this inspection there was twenty nine people at the home and one person was in hospital, the staffing levels on the morning of the 14th were one senior carer and five care assistants, two cleaners, one cook and one catering assistant. We were informed that one of the laundry workers had called in sick and that a member of staff had been arranged to cover this shift. We were told that recruitment advertisements had been posted for a cook, a handyman and an activity person. We were told that at present at weekends no cook is currently available and that temporary arrangements are in place to cover this position with a care worker and an additional member of care staff brought on duty to ensure that the care provision is maintained at the correct levels. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 26 We checked the recruitment files of four staff and it was confirmed that one member of staff had started working at the home without a Criminal records Bureau (CRB) clearance having been obtained. Records within this persons recruitment file evidenced that the CRB was obtained eight weeks after they had taken up employment at the home. There was evidence that the home had carried out a POVA first (Protection of Vulnerable Adults) list prior to the new member of staff starting work at the home. We looked for evidence to demonstrate that over the eight week period that the new member of staff had worked under close supervisory arrangements, as required by the regulations on staff recruitment for this type of service whilst waiting for CRB clearance. We asked to see the staff rota covering the eight week period and was informed that it was unable to be located, a computer printout of the staffing hours was produced which gave the hours worked by the new member of staff, however did not indicate which member of the staff team was responsible for their supervision. On the second day of the inspection a second computer printout of the staff rota was produced covering the eight week period. This had additional handwritten instructions indicating the supervisory arrangements by way of an asterix alongside the name of the new staff member and their designated supervisor. We spoke with staff during the inspection and asked them to explain how new staff are supervised. We were told that they know when they are expected to supervise a new member saying it is indicated on the staff rota by an asterix alongside their name and that this is for the first three days of induction. We asked whether they where aware of having to supervise any staff for longer periods than the normal three days due to waiting for CRB clearance, the staff were unable to give an account of what additional supervisory arrangements there may be required to carry out. At the last key inspection on 8th December 2008 we issued a statutory requirement under regulation 19 schedule 2, this was that ‘only under exceptional circumstances must staff take up employment pending clearance of a CRB check, and in this event the new member of staff must work under strict supervisory arrangements and the employer must be able to evidence how the member of staff has been supervised’. We received an ‘action plan’ from the provider dated 20th February 2009 in which they informed us of the steps taken to address the requirements in this particular instance they stated ‘the manager to ensure that all new staff have in place a CRB prior to starting work’ and the timescale was to be ‘with immediate effect’. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 27 CQC has agreed to allow that staff can begin work under strict supervision in a care home, and only allowed to work unsupervised when a full and satisfactory CRB and POVA check has been received. It should not be taken for granted that all staff can commence working on the basis of having obtained a POVA first clearance. Based upon the ambiguous evidenced produced at this inspection we took the decision to use our statutory powers under sections 31 and 32 of the Care Standards Act 2000 and issue a Code B notice. The reason for the service of this notice was because we believed an offence may have been committed by virtue of failure to comply with a statutory requirement and seized copies of the staff rotas highlighting the discrepancies of the computer print outs obtained on both the 14th and 15th May 2009. After careful consideration of the evidence gathered during the inspection we took the decision to issue a warning letter to the provider as failure to comply with statutory requirements is viewed as a serious breach of regulations. We looked at records of staff induction training, one file had evidence that the induction programme had been completed however the document was still to be signed off by the manager. The other three staff files viewed did not contain an induction booklet to verify that mandatory training had been undertaken. However we did however find copies of moving and handling certificates within their files. It was difficult to establish when staff had received fire awareness training as there were no written records of this training available. In discussion with a member of the night care staff team they confirmed they were aware of the procedures to take in the event of the fire alarm being raised. The staff files contained information on training which had been undertaken in previous work settings. There were no further records that additional training had been undertaken since taking up employment at Cheney House. Two of the files viewed were for overseas workers and there was evidence that all the information supplied within the application form had been verified by the National Recognition of Information Centre in the UK. There was also confirmation that medication training had been completed prior to them taking on the responsibility for administering medication. In discussions with the staff team they demonstrated that they are dedicated in providing care for the people using the service and had an adequate range of knowledge about the needs of people living at the home. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 28 Due to the continued absence of a manger at the home formal supervision has not been routinely available and therefore staff have not had the opportunity to reflect on their care practices and identify their individual learning objectives. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35 & 38 People using the service experience adequate quality outcomes in this area. Communications between the home and the regulatory, health and social care bodies has improved. However the continued absence of a home manager and inconsistencies in the homes record keeping systems continues to hinder the progress of the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since the last key inspection the previous registered manager had left employment and has returned back in the position of deputy manager. A new manager has been appointed, an application to register as the manager with the Care Quality Commission has yet to be submitted. The new manager Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 30 has had an extended period of leave which has left the home without permanent management cover. We were informed that Regal Care has addressed this by bringing in the area manager to provide temporary management cover three days a week. There were records of available of monthly Regulation 26 visits by the area manager to look at the care provided at the home, which include health and safety checks and supervision of the manager. Whilst the manager is on extended leave the area manager has been monitoring the work carried out by the deputy manager. This is to ensure that the management of the home continues to promote and protect the people using the service. We checked the finances of three people using the service and found the balances and accounts to be correct. As identified within the specific outcome areas of this report we found shortfalls in record keeping and have issued requirements for these to be addressed. It is recognised that Cheney House has been going through a difficult period and the continued absence of a manager has impacted on the development of the home. The company has been cooperative in responding to areas of concerns that have been raised by the regulatory, health and social care bodies and in responding to complaints. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Each person moving into the home must have a fully completed pre admission assessment which is cross referenced with information from health and social care assessments of the person. This is to ensure that care plans can be formulated to meet the full range of needs of people using the service. 2 OP7 14 (2) (a) (b)15 (2) (b) The changing needs of people using the service must be entered into their individual care plan without delay and risk assessments kept under review to reflect the changing needs. This will ensure that all staff are fully aware of the current needs of service users and that their health, safety and welfare is promoted and protected. 3 OP9 13 (b) Where medication is administered through any other method than the prescribed method, the medical practitioner DS0000012735.V375604.R01.S.doc Timescale for action 31/07/09 31/07/09 31/07/09 Cheney House Version 5.2 Page 33 must have stated that the person lacks ‘the capacity to consent to treatment’ and that the medicine is essential to their health and well-being. Medication must not be mixed with food or drink without agreement being sought from the dispensing pharmacy on the suitability of the medication to be given in this form. 4 OP18 19 Schedule 2 It must only be under exceptional circumstances that staff take up employment without the home first obtaining clearance with the Criminal Records Bureau (CRB), in this event the new member of staff must have had a check carried out with the Protection of Vulnerable Adults (POVA) list. The member of staff must only work under strict supervisory arrangements. In this event the employer must be able to evidence the supervisory arrangements in place covering the period from when the member of staff started working at the home and the date that the CRB clearance was obtained. This is to ensure that people using the service are protected. 5 OP18 13 (6) All staff must receive training on the safeguarding of vulnerable adults (SOVA) to include whistle blowing procedures This will ensure that people using the service are safeguarded from abuse. Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 34 31/07/09 30/09/09 6 OP19 23 Call bell facilities must be made available in all bedrooms of people using the service and in shared rooms there must be one call bell available per person. This is to ensure that people using the service can summon assistance when required. 31/08/09 7 OP30 18 (c) (i) (ii) There must be a staff training and development programme in place which meets the changing needs of service users. This will ensure that staff have the necessary skills and experience to meet the needs of the people using the service. 31/07/09 8 OP37 12 (1 ) (a) The homes fire log must have an 31/07/09 up to date list of all the people using the service, indicating their bedroom location and mobility abilities. This is to ensure that in the event of an emergency evacuation the fire personnel are fully aware of the location of each person’s individual living space, and their mobility abilities in order to provide assistance in evacuation. 9 OP37 17 (1) (a) Schedule 3 The register of people using the service must be kept up to date to include admissions, deaths, discharges and temporary discharges and be fully accessible. This is to provide a clear audit trail of the number of people at the home, admissions, discharges and deaths at the home. DS0000012735.V375604.R01.S.doc 31/07/09 Cheney House Version 5.2 Page 35 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP18 Good Practice Recommendations The staff recruitment practice should ensure that references from an applicants previous employer are sought and that To Whom it May Concern references are verified. This is to ensure the safety of people using the service is protected. All fire exits at the home should be routinely checked to ensure that these are in working order and accessible. This is to ensure that exit routes are not obstructed by the inability to break the safety glass and allow free passage in the event of evacuation. 2 OP19 Cheney House DS0000012735.V375604.R01.S.doc Version 5.2 Page 36 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastmidlands@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. 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