Inspection on 02/04/09 for Chestnut View Care Home

This inspection was carried out on 2nd April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chestnut View Care Home 16/07/07

Chestnut View Care Home 13/03/07

Chestnut View Care Home 15/06/06

Chestnut View Care Home 27/10/05

Chestnut View Care Home 30/08/05

Chestnut View Care Home 06/07/04

Chestnut View Care Home 19/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Chestnut View Care Home Chestnut View Care Home Lion Green Haslemere Surrey GU27 1LD     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Suzanne Magnier     Date: 0 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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: Chestnut View Care Home Lion Green Chestnut View Care Home Haslemere Surrey GU27 1LD 01428652622 01428651145 admin@chestnutview.plus.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St Cloud Care Plc Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 60 Number of places (if applicable): Under 65 Over 65 0 60 dementia old age, not falling within any other category Additional conditions: 60 0 The maximum number of service users who can be accommodated is 60 The registered person may provide the following categories of service only -Care home with Nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category(OP) Date of last inspection Brief description of the care home Chestnut View is a large detached property owned and managed by St Cloud Care plc. The service currently provides twenty four hour care for up to sixty older people. The property is close to the local town centre and a large supermarket and is within walking distance for those who are able to walk short distances. Care Homes for Older People Page 4 of 34 Brief description of the care home All rooms are single occupancy with en suite facilities and there are spacious communal areas throughout the home including dining rooms. A separate unit for people with Dementia and or Alzheimers is available, which also has a separate garden for people to use. The home has well maintained gardens and ample parking arrangements. 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 0 star. This means that the people who use this service experience Poor quality outcomes. The last inspection on this service was completed on the 16th July 2007. This inspection of the care home was an unannounced Key Inspection. Ms S Magnier and Mrs L Garrett Regulation Inspectors carried out the inspection and arrived at the service at 08.00 and were in the home for eight hours. The service was represented by the Operations Manager and the homes Deputy Manager as the Registered Manager was on annual leave. It was a thorough look at how well the service was meeting the Key National Minimum Standards for Care Homes for Older People and has in this report made judgements about the standard of the service. For the purpose of the Care Homes for Older People Page 6 of 34 report the individuals using the service are referred to as individuals or residents. The CSCI Inspecting for Better Lives involves an Annual Quality Assurance Assessment to be completed by the service, which includes information from a variety of sources. This document was received by the commission and reference to the AQAA was made whilst undertaking the key inspection and developing the report. The commission received responses to questionaires sent prior to the inspection and these were discussed with the responsible individual and operations manager following the inspection. The information contained in this report was gathered from observation by the inspector and speaking with a number of residents and care staff. A tour of the premises was undertaken and documents sampled during the inspection included some peoples care plans, daily records and risk assessments, medication procedures, health and safety records, staff training and recruitment records, and some of the homes policies and procedures. The final part of the inspection was spent giving feedback to the service representatives about the findings of the visit. The commission have been made aware of one safeguarding vulnerable adult referral and some concerns that the commission have received regarding the home. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of clients who have diverse religious, racial or cultural needs. The commission have noted that all requirements made during the last inspection in July 2007 have been complied with in order to improve the services to the older people receiving care and accomodation at the home. What the care home does well: What has improved since the last inspection? What they could do better: Written information regarding the services and facilities provided by the home was not up to date and would not support prospective individuals and their representatives to make an informed choice about moving to the home. People are offered an adequate provision of health care and personal support by the home. The care planning system, monitoring of risk assessments and medication procedures of the home need to be improved to ensure that peoples health, safety and wellbeing is robustly promoted. The serving of breakfasts and dining arrangements, particularly within the reminisence unit need to be reviewed in order to ensure people have the appropriate level of support available to them at meal times and receive meals at appropriate times during the day. People in the home are not fully protected by the homes complaints and safeguarding adults procedures. Staff in the home are not fully trained, and in sufficient numbers to support the people who use the service. The home does not have a robust system for the induction and training development Care Homes for Older People Page 8 of 34 programme for staff to ensure peoples needs are met appropriately and safely. Management of recruitment files were adequate to protect the welfare and safety of individuals living at the home. The management of the home is not robust to ensure the safety and wellbeing of individuals and the manager must undertake from time to time such training as is appropriate to ensure that they have the experience and skills necessary for managing the care home. Arrangements must be made for the robust management of staff supervision in order to ensure staff are supported and managed well. 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 set out 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Written information regarding the services and facilities provided by the home was not up to date and would not support prospective individuals and their representatives to make an informed choice about moving to the home. The admission and assessment procedures ensure that peoples needs are identified and met. Residents or their representatives have a written contract regarding the terms and conditions of residency. Intermediate care is not currently offered. Evidence: The homes Statement of Purpose and Service User Guide sampled during the inspection were not up to date and did not contain the required information to inform prospective residents and their representatives about what the home offers. The general manager advised that updated documents had been supplied to the home by St Cloud Care yet these had not been filed and managed accordingly in order to ensure that people had up to date information about the home. Care Homes for Older People Page 11 of 34 Evidence: Following the inspection the operations manager contacted the commission to confirm that the current documents would be sent to the commission. It has been required that arrangements must be made that the homes Statement of Purpose and Service User Guide are kept under review and the information contained within the documents complies with the Care Home Regulations. One residents contractual affairs were discussed with the operations manager who advised that the residents queries about their contract had been addressed with the individuals representative during the day of the inspection. Five resident care plans were sampled during the inspection and all contained information to confirm that the individuals needs had been assessed by a member of staff with the ability and qualifications to undertake the assessment prior to the persons admission to the home in order to ensure that the homes staff could meet the individuals care and support needs. No intermediate care is currently offered by the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are offered an adequate provision of health care and personal support by the home. Care is provided in way that protects the individuals privacy and dignity. The care planning system, monitoring of risk assessments and medication procedures of the home need to be improved to ensure that peoples health, safety and wellbeing is robustly promoted. Evidence: The five care plans sampled related to individuals who were residing within the nursing, residential and reminiscence unit which supports people diagnosed with dementia. There was evidence to support that the care plans had been developed from the pre assessment documentation and included the individuals care and support needs. The care plans were generally well written to allow the reader to gain an overview of the persons medical, emotional, social and personal care needs and included documentation regarding complexities in peoples communication, sensory Care Homes for Older People Page 13 of 34 Evidence: impairments, mobility and behaviours which may test the service. The AQAA indicates that over the last twelve months there have been barriers to improvement which have involved the care planning systems with trained staff finding the new care planning system difficult to use as within the nursing unit the care plans are more complex. During the inspection it was acknowledged that the care plans for people receiving care and support in the residential and reminiscence units were more effectivley managed and person centred than the care plan documentation on the nursing unit. This was discussed with the general manager who advised that the homes senior management were aware of the shortfalls and measures were in place with the deployment of the deputy manager working on the nursing unit to assist in addressing some of the shortfalls. During the inspection it was confirmed that the operations manager has undertaken care planning training with staff and a process of archiving past care plans is in place. It had been identified by professionals visiting the home prior to the inspection that one persons healthcare appointments had not been attended and as a result the operations manager had undertaken an audit of the care plans which highlighted several shortfalls with the current care planning procedures and documentation. It has been required that arrangements must be made to promote more fully and make proper provision for the health and welfare of individuals by a more robust care planning system. As previously documented a selection of care plans were sampled and it was noted that the care plans included written guidance on how the individual liked to be supported, their likes and dislikes, their communication and sensory abilities, medication requirements, specialist care being provided, day and night time choices and preferences. The care plans included each persons health profile, their nursing and dietary requirements including body weight charts which are monitored regularly to indicate weight loss or gain, skin integrity, safe moving and handling procedures and mobility assessments. Care records were professionally written and generally well maintained to reflect the individuals needs and care provided. From the care plans sampled there was documented evidence that regular and appropriate health care appointments including visits by the general practitioner had been attended either in the home or by visiting the local health care services and the home maintains good working partnerships with health care professionals which include visits from the opticians, dentists, chiropodists and district nurse visits to people in the residential and reminiscence unit should their needs change. Care Homes for Older People Page 14 of 34 Evidence: The sampled care plans contained completed risk assessments which had been completed following identification of hazards in peoples daily lives and promoted peoples independence whilst ensuring their safety and wellbeing. One risk assessment was discussed with the deputy manager as the hazard had not been fully explained and documented within the assessment. It has been required that all risk assessments must be fully written in order that staff are aware of the hazards and the measures in place to keep the individual as safe as reasonably practicable. It was observed that the majority of individuals residing in the nursing unit had bed rails in use. The care plans contained risk assessments for the use of the bedrails yet it was noted that the risk assessments were based on the individuals skin integrity assessment which was not considered a relevant assessment for the use of bed rails. This was discussed with the operations manager who confirmed that the assessments were not appropriate to determine the use of bed rails. It has been required that arrangements must be made for an appropriate risk assessment for the use of bed rails be implemented in order to ensure individuals safety and well being and also to promote best practice. The home has a medication policy and procedure in place and has been supplied with a monitored dosage system. Several medication administration charts were seen which were generally well documented however concern had been raised by the registered nurses regarding the way in which an individuals medication administration sheet had been documented by a visiting health care professional. This matter was being addressed by the operations manager prior to the inspection who assured the commission that she had been in contact with the local dispensing pharmacist, the individuas general practitioner and the prescribing nurse in order to ensure the safety and well being of the person whilst receiving their prescribed medication. It was observed that the morning medication rounds on the nursing and reminiscence unit were delayed and took a long time to administer which was discussed with the staff members during the inspection and concluded that there needed to be a review of the deployment of staff at the busy times of the day. The operations manager confirmed that generally a staff member from the residential unit goes to the reminiscence unit during the breakfast time to support staff yet this did not happen on the day of the inspection. It has been required that the arrangements regarding the administration of medicines in the home be reviewed in order that individuals receive their medication within the prescribed timescales and staff handle and administer medicines in a safe manner. It was confirmed that people have a right to refuse their medication and that the home Care Homes for Older People Page 15 of 34 Evidence: promotes peoples rights to independence and where possible following assessments people would be supported to manage their own medication. Throughout the day it was observed that individuals were addressed in a polite and courteous way by staff. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make some choices about their daily routines and enjoy and choose from a range of activities offered by the home. Visitors are welcomed to the home to maintain contact with their family members and friends. The home provides a healthy and balanced diet. The serving of breakfasts and dining arrangements need to be reviewed in order to ensure people particularly within the reminiscene unit have the appropriate level of support available to them at meal times and receive meals at appropriate times during the day. Evidence: The home has promoted an activities programme which is provided by the activities organisers. Several individuals told the inspectors that there are a range of activities provided at the home and also some activities which involve the local day centre which is very near to the home and where people can attend if they choose to. It was noted that a document detailing forthcoming events were distributed and displayed around the home so people knew what was on offer if they would like to attend. Some people said they did not like to get involved in the activities and were happy to busy themselves and do what they wanted. Care Homes for Older People Page 17 of 34 Evidence: There are numerous areas within the home where people could sit and take leisure time. In the lounge areas bookcases were well stocked with a variety of interesting books, jigsaw puzzels were available and one puzzle was near completion, clocks were available for people to see the time, large screen televisions were available and one person said they liked the large screen as it was easy to see. Several people said they liked where the home was situated as they could see the coming and goings of life outside and also enjoyed visiting the local supermarket in close proximity to to the home and enjoyed it when choirs came to the home. The staff have started to develop life history memory boards and specialist signage which are situated by the individuals room on the reminiscence unit which help people to orientate where they are and have something familiar to look at if they wish to. Textured wall hangings and areas of interest have also been designed and the unit is enclosed which offers individuals space to move around freely with safety. Links have been maintained with the local clergy and multi denominational services are held at the home to support peoples spiritual and religious needs. People confirmed that their friends, family and people that are important to them and are welcomed into the home during the open visiting hours. On arrival at the home breakfasts had not been served and it was observed that a large number of people on the nursing unit were in bed. Individuals from the the residential unit were sitting in the main hallway landing on the middle floor waiting for breakfasts to be served. When asked people said they generally sat and waited which was a good time to have a chat with each other and they didnt mind waiting and confirmed that they had a choice if they wanted to have their breakfasts in their rooms yet one person said they sat there so as not to be in the staffs way. This information was relayed to the operations manager following the inspection and it has been recommended that during a residents meeting that peoples rights to choice and preferences be adressed in order that people know they are free to make choices about their daily lives. During the inspection concern was raised about the deployment of staff as one person sitting on the landing was seen to be unable to leave their armchair to go and have breakfast as another person using a wheelchair had been placed by staff in front of the armchair. Observation during the breakfast time on the reminisence unit confirmed that one staff member was supporting nine individuals in the dining room with their breakfast being served at 09.10. The tables were not covered with table cloths, people had insufficient cutlery available to them, few condiments were available, napkins were placed on the table yet were not used, one person was sleeping and despite the staff members efforts people were left waiting for their breakfasts to be served. It has Care Homes for Older People Page 18 of 34 Evidence: been required that the dining arrangements and the serving of the breakfasts be reviewed in order to ensure that staff are in sufficient numbers to offer support and guidance to individuals at mealtimes in order to ensure the individuals safety and wellbeing. It was confirmed by staff that breakfasts were generally served at 09.30 and at least two other people within the remininence unit were in bed. One person in bed was distressed and asked to have a drink as they were thirsty to which the staff member responded to promptly following the inspectors intervention. During the feedback at the end of the inspection these shortfalls were raised with the operations manager who confirmed that the evening meal would have been served at 18.30 the previous evening but drinks and snacks are made available at all times as the homes kitchens were open 24 hours per day. It was observed that people were offered a choice of meals at breakfast which included cereals and a hot cooked breakfast of scrambeled eggs and a menu was available for people to see what was on the days menu. The large residential unit dining area has significantly improved in decor following the previous inspection with the tables set with linen table cloths, centre pieces, condiments, napkins and appropriate cutlery available. Meals were served from a heated trolley in all dining areas of the home and people confirmed that they felt the meals were good. The AQAA details that the chef has regular discussions with people at the home regarding their preferences and choices and changes have included homemade cakes with afternoon tea and a desert with the evening meal. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home are not fully protected by the homes complaints and safeguarding adults procedures. Evidence: The complaints procedure supplied during the inspection was not dated and contained out of date information for a person to contact the Commission about the home should they choose to. The AQAA advises that the home have received five complaints in the last twelve months. The complaints log was sampled and confirmed that the complaints had been received yet not all complaints had been responded to promptly which had resulted in the complainant addressing the complaint again with the homes management. There was evidence to support that some complaints had been investigated and that satisfactory conclusions had been reached. It has been required that arrangements must be made that the home has an up to date complaints procedure which includes the commissions details and that all complaints received by the home are fully investigated and acted upon promptly. The home has a copy of the Surrey County Council Multi agency Procedures for Safeguarding Vulnerable Adults and a whistle blowing policy and procedure. Care Homes for Older People Page 20 of 34 Evidence: Five staff files were sampled and one indicated that the newly appointed staff member had not received safeguarding vulnerable adults training despite being in daily contact with individuals supported at the home. Records regarding staff attending safeguarding vulnerable adults training were not readily available during the inspection and following the inspection the operations manager confirmed in writing to the commission that the staff training matrix would be sent to the commission. The training matrix was received by the commission following the inspection and the document identified that sixty two staff were listed on the matrix of which thirty nine staff had not received safeguarding vulnerable adults training. It has been required that arrangements must be made for all staff to attend safeguarding vulnerable adults training and that the homes staff comply with the local authorities protocols regarding the reporting of any alleged harm or abuse in order to ensure the safety and well being of individuals at the home. St Cloud Care confirmed in writing to the commission following the inspection that staff safeguarding training had been arranged following the inspection and would be held over two days within the current month of April 2009. One staff file sampled evidenced that no CRB disclosure number was documented and two staff files evidenced that the CRB checks had been obtained over three years ago. The operations manager confirmed in writing following the inspection that a CRB clearance had been obtained for a newly recruited staff member but had not been documented within their file and advised that it was not St Cloud Care practice to update CRB checks after three years as suggested good practice. Whilst sampling the complaints log it was noted that a complaint received by the home alleged that a staff member had acted inappropriately towards an individual at the home and this had not been reported to the local safeguarding team but addressed by the registered manager. The commission have received concerns regarding the general management of the home, the management of care planning and shortfalls in the provision of care for people in the home which could potentially affect the welfare and safety of individuals in the home. These issues were discussed with the operations manager during the inspection. 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 who use the service live in a safe and well maintained environment. In general all areas of the home are clean and hygienic. Evidence: The home has an infection control policy in place and staff are trained and aware in infection control procedures and were observed adhering to infection control measures for example wearing protective clothing, washing their hands and using hand gels to prevent the spread of infection in the home. There is a daily cleaning schedule in place and the home was well maintained. There was one area in the home where there was malaodour and staff and the general manager confirmed that the housekeeping staff were aware of the concern and actions were being taken by the homes management to address the issue. Written comments received by the commission were varied regarding the standard of cleanliness in the home and these matters were addressed with the responsible individual and operations manager following the inspection. Care Homes for Older People Page 22 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. Staff in the home are not fully trained, and in sufficient numbers to support the people who use the service. The home does not have a robust system for the induction and training development programme for staff to ensure peoples needs are met appropriately and safely. Management of recruitment files were adequate to protect the welfare and safety of individuals living at the home. Evidence: The home is currently supporting 53 individuals and has a total of 68 staff including ancilary workers and it was observed that the staff team consisted of a multi cultural workforce. As previously documented the staffing deployment and resources on the day of the inspection were observed to be insufficient to meet the current needs of some of the people in the home and staff were not able to be prompt to support individuals who required immediate assistance. Time management in the home regarding the administration of medicines, provision of support and care for people who relied on staff support and the serving and supporting people at mealtimes was not well managed due to insufficient staff deployment and resources. It has been required that the staffing levels and deployment of staff within the home be reviewed in order to ensure that the needs of people within the home are met appropriatley and promptly. Care Homes for Older People Page 23 of 34 Evidence: People living at the home spoke highly of the staff and how hard they worked. Some staff commented that they try their best to do their job well but sometimes it was difficult due to the workload and it was difficult to get everything done in the shift. The inspectors sampled five staff recruitment files. In general the files evidenced that the home undertakes safe vetting practices concerning the recruitment of staff in order to ensure the safety and protection of people living in the home yet there were some shortfalls which included the lack of good quality photo identity in two files. The staff mandatory training records were sampled and evidenced that there were shortfalls within four of the files and there was no training matrix available within the home to sample at the time of the inspection. Following the inspection the commission received the training matrix which included sixty eight staff. Significant shortfalls were identified which included no evidence that fifty four staff, including the deputy manager had received induction training, sixty staff had not received first aid training, fifty one staff had not received moving and handling training, sixty four staff had not received food hygiene training and forty eight staff staff had not received health and safety training. The training matrix also identified that no staff had received training to support people with Dementia. Following the inspection the responsible individual and the operations manager have been proactive in arranging staff training and a significant number of staff have received mandatory training following the inspection. It was noted from evidence in a staff file and whilst speaking with the operations manager that that there was not a robust induction programme available at the home for staff. The AQAA advises that 32 staff have achieved their National Vocational Qualification in Level 2 or above yet the training matrix received from the home by the commission indicates 20 staff have achieved the qualification. The AQAA also details that there are plans for the nurses to receive training in specialist subjects such as tissue viability, diabetes and continence management. Some care staff working on the reminiscence unit advised that they had received dementia care training which had helped them in their work yet this was not documented within the training matrix supplied to the commission. It has been required that all staff must attend an induction programme which is in line with the Skills for Care council and all mandatory training must be updated in order to ensure that the homes staff are suitably trained and competent in their duties. The home had a relaxed atmosphere and staff were observed to undertake their tasks Care Homes for Older People Page 24 of 34 Evidence: in a quiet and orderly manner. The inspector observed staff interactions with people all of which were supportive and friendly. 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. The management of the home is not robust to ensure the safety and wellbeing of individuals. Residents are consulted regarding the running of the home and their financial interests are safeguarded. The health and safety of all persons in the home is promoted through general health and safety checks. Formal staff supervision is not consistent and needs to be implemented. Evidence: The registered manager was on annual leave and therefore was not present during the inspection. There was evidence to support that peoples views and opinions of the home are actively sought and resident meetings held in order that people can talk about their experiences of the home and put forward ideas about the home for improvement. The organisations Operations Manager undertakes unannounced Regulation 26 visits Care Homes for Older People Page 26 of 34 Evidence: and any shortfalls in the quality of the service are noted during the visits so that appropriate action is taken to rectify the shortfalls. Records evidenced that the visits had taken place regularly and some of the shortfalls identified during the inspection were being addressed by the homes management prior to the inspection in order to improve the care and support for people residing and receiving care at the home. The Operations Manager advised that no peoples monies are kept by the home on their behalf and individuals are encouraged to keep their own money. It was observed during the tour of the premises that chemicals were stored appropriatly, fire fighting and moving and hanling equipment had been regularly serviced, fire and water temperature safety records had been maintained. Whilst sampling the staff files it was noted that there was little evidence to support that staff received ongoing support and supervision of their work. The arrangements of the supervision of staff and issues of management accountability were discussed with the Operations Manager for staff to be provided with and receive formal supervison and support. It has been required that arrangements must be made for the robust management of staff supervision in order to ensure staff are supported and managed effectively. Accident and incident records were sampled which indicated that events which affect the wellbeing and welfare of individuals are reported to the commission. As recorded throughout the report a large number of aspects of the homes management are potentially putting the health, safety and welfare of individuals and staff at risk including the lack of up to date information about the services provided at the home, shortfalls in the care planning system, lack of robust monitoring of risk assessments, concerns regarding the medication procedures of the home, shortfalls regarding the deployment of staff to meet the current care needs of individuals at the home, lack of staff availability to support individuals at meal times and offer a postive dining experience leading to loss of dignity and respect, shortfalls in the complaints and safeguarding procedures and lack of robust training, appropriate induction and supervision of all grades of staff. It has been required that arrangements must be made to ensure that the home is more robustly managed in order to ensure that the safety and welfare of all persons in the home is promoted. It has been required that the home must forward to the commission an improvement plan detailing how the home intends to improve the services provided in the home to ensure the safety and well being of residents in the home. Care Homes for Older People Page 27 of 34 Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 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 1 4 Arrangements must be 16/05/2009 made that the homes Statement of Purpose and Service User Guide are kept under review and the information contained within the documents complies with the Care Home Regulations. In order to ensure that individuals have up to date information about the services provided at the home. 2 7 13 Arrangements must be 15/06/2009 made for appropriate risk assessments be documented for the use of bed rails. In order to ensure individuals safety and well being and also to promote best practice. 3 7 13 Arrangements must be made that all risk assessments must be fully written. 15/06/2009 Care Homes for Older People Page 30 of 34 In order that staff are aware of the hazards and the measures in place to keep the individual as safe as reasonably practicable. 4 8 12 Arrangements must be made to promote, more fully, and make proper provision for the health and welfare of individuals by a more robust care planning system. In order to ensure that peoples needs are consistently met. 5 9 13 Arrangements regarding the administration of medicines in the home be reviewed in order that individuals receive their medication within the prescribed timescales and staff handle and administer medicines in a safe manner. 11/05/2009 15/06/2009 In order to ensure the safety and welfare of individuals receiving their prescribed medication. 6 14 13 The dining arrangements and the serving of breakfasts must be reviewed. In order to ensure that staff are in sufficient numbers to offer support and guidance to individuals at mealtimes in order to ensure their 18/05/2009 Care Homes for Older People Page 31 of 34 safety and wellbeing. 7 16 22 Arrangements must be made that the home has an up to date complaints procedure which includes the commissions details and that all complaints received by the home are fully investigated and acted upon promptly. In order to ensure that peoples concerns or complaints about the home are promptly addressed and actions taken. 8 18 13 Arrangements must be made for all staff to attend safeguarding vulnerable adults training and that the homes staff comply with the local authorities protocols regarding the reporting of any alleged harm or abuse. In order to ensure the safety and well being of individuals at the home. 9 31 9 Arrangements must be made to ensure that the home is more robustly managed. In order to ensure that the safety and welfare of all persons in the home is promoted. 10 31 18 Arrangements must be made that all staff must attend an induction programme which is in line 15/06/2009 15/06/2009 18/05/2009 18/05/2009 Care Homes for Older People Page 32 of 34 with the Skills for Care Council and all mandatory training must be updated. In order to ensure that the homes staff are suitably trained and competent in their duties. 11 36 18 Arrangements must be made for the robust management of staff supervision. In order to ensure staff are supported and managed effectively. 15/06/2009 12 38 24A The homes management 31/07/2009 must forward to the commission an improvement plan detailing how the home intends to improve the services provided in the home. To ensure the safety and well being of residents in the home. 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 14 It has been recommended that during a residents meeting that peoples rights to choice and preferences be adressed in order that people know they are free to make choices about their daily lives. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI 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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