Inspection on 08/07/09 for Church Farm

This inspection was carried out on 8th July 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Church Farm 01/05/09

Church Farm 11/12/08

Church Farm 03/07/07

Church Farm 13/10/06

Church Farm 06/09/05

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

Key inspection report Care homes for older people Name: Address: Church Farm Yarmouth Road Hemsby Great Yarmouth Norfolk NR29 4NJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Craig     Date: 0 8 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Church Farm Yarmouth Road Hemsby Great Yarmouth Norfolk NR29 4NJ 01493730181 01493531599 rsonshomes@btopenworld.com rsonshomes@btopenworld.com R Sons (Homes) Limited care home 40 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Church Farm offers residential accommodation to a maximum of 40 people, most of whom have needs associated with dementia. The building is a period residence that has been adapted over the years to meet the needs of older people and extended to include purpose built accommodation. Bedrooms are situated on the ground and first floors. Twenty-four of the rooms have en suite facilities and all others have washbasins with access to WCs and bathrooms close by. There are separate communal areas and a conservatory, which has been designated as a smoking area for residents. The grounds are well maintained comprising of a garden and large car park at the front of the property and a courtyard in the centre of the home. Church Farm is located in the seaside village of Hemsby, 5 miles north of Great Yarmouth. The home is situated in a quiet location away from the main centre of Hemsby and is within walking distance of the local shop. There are very few local facilities, however it is a short drive to the Care Homes for Older People Page 4 of 32 Over 65 28 12 0 0 1 1 1 2 2 0 0 8 Brief description of the care home town of Great Yarmouth, which has numerous shops and other facilities. The surrounding areas of Hemsby also offer a number of pubs and restaurants situated on the edge of the broads that can provide some very pleasant outings. The fees range from £350 to £464 per week. Extra charges are made for hairdressing, chiropody, nespapers and toiletries. Information about the home, including the latest inspection report, is available from the manager. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection on this service was completed on 13th January 2009. There was also an extra inspection on 1st May 2009. This random inspection was carried out by the pharmacist inspector in response to a number of concerns that had been identified in January, about the management of medicines. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 8th July 2009 by one regulatory inspector. At the time of the visit there were thirty five people resident in the home. We met with some of them and asked about their views of Church Farm. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. Care Homes for Older People Page 6 of 32 We talked to the registered manager and other members of the staff team. We looked around the home and viewed a number of documents and records. As part of the key inspection surveys were sent out to people living and working at Church Farm. Residents were assisted to complete the surveys by family members. All their responses have been taken into account when making judgements about the service. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: At the last inspection the overall rating for the home was 0* poor. We made a number of requirements and recommendations to improve the quality of the service. The majority of these had been actioned, although in several cases there were still further improvements to be made. There are two outstanding requirements. The manager was aware of and working towards meeting these, therefore we have extended the timescale for compliance. There was not enough monitoring or investigation when residents had unexplained injuries. We made a requirement that staff audit unexplained injuries to see whether there were any patterns and investigate them to see whether anything could be put into place to prevent them in the future. We also recommended that falls and other accidents be audited to highlight potential patterns and assist staff to draw up plans to reduce the risk. Care Homes for Older People Page 8 of 32 Hazards to residents health and safety caused, for example, by the use of bed rails and unguarded wall heaters, must be assessed and plans must be drawn up to try to minimise the risk. On the day of the visit most residents were not engaged in any stimulating or meaningful activity for long periods. Staff told us that this was not uncommon. Residents and /or their representatives must have access to a clear complaints procedure that is in a suitable format to meet their needs. This is to ensure that peoples right to complain is protected. Procedures to guide staff what to do if they suspect a resident is the victim of abuse should be made clearer. The systems for monitoring and improving the quality of the service must be further developed. Quality monitoring helps the manager to identify shortfalls in the service and put them right. It ensures the home is run in the best interests of the residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of moving into the home received sufficient information to help them to make a decision and staff received sufficient information to understand the persons needs. Evidence: The service users guide had very recently been updated. The document provided people with a good explanation of the services they should receive and the terms and conditions of the home. It was only available in one format, which people with dementia might find difficult to read and understand. However, most residents who completed surveys said they received enough information about the home to help them to make a decision about moving in. The annual quality assurance assessment (AQAA) told us that the service had a good admission process, which meant that they rarely had failed placements. The manager told us that they obtained social work assessments for people thinking of moving into Care Homes for Older People Page 11 of 32 Evidence: the home and also carried out their own pre-admission visits. We saw two examples of pre-admission assessments that had been carried out by senior staff from the home. Although one was very brief, the other included essential information and gave staff a balanced view of the needs and abilities of the new resident. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in care planning meant that residents health and personal care needs were understood but shortfalls in medicines management could place some residents at risk. Evidence: We looked at three sets of care records as part of the case tracking process and viewed others to check specific issues. A new care plan format had been introduced since the last key inspection. Residents had a new set of records which included; a recent assessment, risk assessments, care plans and associated progress records. As we had required following the last inspection, all records were signed and dated. The assessments we looked at provided a clear picture of the residents needs, abilities and preferences in all areas of daily living. Corresponding care plans were individualised and, in most cases, gave staff clear directions about how the resident preferred to be cared for. Plans to support residents with their personal care also included directions to help them to maintain their independence. Care Homes for Older People Page 13 of 32 Evidence: One of the care files we saw had been signed by a relative, who indicated they agreed with the plans. Another relative also told us that they had been involved in drawing up and reviewing their mothers care plans. Plans were to be reviewed each month and we saw that one had already been updated to reflect the change in the residents needs. Following a previous requirement, each resident had assessments to identify potential risks of falls, pressure sores, poor nutrition and moving and handling. Where specific reasons for the resident being at risk had been highlighted, there were some good strategies in place. For example, one resident fell because they were unsteady when they stood up, and their plan focused on this hazard. However, falls were not audited, which could prevent staff from identifying and eliminating certain patterns and trends. The manager told us that anyone with more than a medium risk of falls was to be referred to the falls prevention team for advice. The team were also going to provide some training for staff. One of the residents we case tracked had a number of unexplained bruises and a skin tear. The injuries had been recorded and treatment given where appropriate but they were not followed up to try to identify and eliminate the cause. Several residents had bedrails in place. There were no assessments to find out whether the use of bed rails was appropriate. There were no risk assessments to show that the bed rails in use were suitable for the resident, the bed and the mattress. There were no ongoing maintenance checks to ensure that the rails remained safe. The manager showed us a sample of an appropriate risk assessment that she planned to put into place. There were records to show that residents were referred to health care professionals whenever necessary. One of the residents we case tracked had an ongoing physical health care need and there was a good plan to alert staff when to call for emergency aid. There were also specific plans to support people with dementia, although some of these needed further development. The surveys we received indicated that residents were satisfied with the level of care and medical support in the home. People we spoke to during the visit confirmed this. One relative told us, They get very good care, I come in often and I like what I see. A resident also told us, I can honestly say I get very good care. Following a requirement at the last inspection to promote residents privacy and dignity, we noted that residents had their own toietries in their bedrooms. The use of Care Homes for Older People Page 14 of 32 Evidence: CCTV had also been identified as potentially compromising privacy. Following discussions with the police and social services, the manager had taken the decision to remove some of the cameras but leave those that provided security at the entrance and fire exits. Information about the cameras was included in the revised service users guide. During the visit we noted that some of the bedrooms were overlooked by residential houses but there were no net curtains or privacy blinds up at the windows. This could be especially important for residents who may forget to draw their curtains when using a commode or residents who spent long periods of time in bed. Residents we spoke to said that staff protected their privacy. One said that staff always knocked on her door if it was closed. Another said that staff were always polite. During the course of the visit we heard staff address residents in a respectful manner. Since the random inspection to assess medication practices, all staff with responsibility for handling medication had received training. A second, more in-depth course was also booked. Residents had a medication profile for reference purposes. Following a previous recommendation these were updated when the residents prescription changed. There were records of medicines received but the records of stocks of medicines carried over from the previous month were still not accurate, which meant there was not a full audit trail. We were able to check some medicines that were not included in the monitored dose system and we found these accurately matched the records. Handwritten entries on medication administration record (MAR) charts were not signed and there was no evidence that they were checked, which could increase the risk of transcribing errors. The MAR charts indicated that residents were receiving their oral medication as it was prescribed. However, despite a previous requirement, there were still no records to show that prescribed creams were administered. There were new, lockable, cabinets in all bedrooms to store creams and other potentially hazardous items. We made a requirement after the random inspection that residents who were receiving their medicines covertly must be assessed with regard to their capacity to consent to treatment, and a decision made about their best interests. We looked at records for two such residents. One had a clear care plan to indicate that they had been assessed by their GP and having their medicines administered covertly was in their best interests. The assessment and plan had not been completed for the other Care Homes for Older People Page 15 of 32 Evidence: person. Some medication was prescribed to be given when required. As we recommended at the last inspection, there were care plans in place to direct staff as to when this medication should be given. Some residents were prescribed variable doses of medicines. We made a requirement at the last inspection that the exact dose administered must be recorded. Staff recorded the dose of painkillers they administered, but not doses of other medicines, for example, Lactulose. Controlled drugs were stored and administered according to guidance. The register had been amended to record the name and dose of the drug on each page. The manager had commenced medication audits and planned to increase the frequency of these in view of the above shortfalls we found during the visit. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The level of stimulation and organised activities did not meet the social and recreational needs of all the residents. Evidence: Some of the families of residents who had dementia, had drawn up life histories, which gave staff background information and provided topics for discussion. The new assessments also included information about residents past and present social interests. However, this information was not transferred to individual care plans and the general activity programme was not based on this information. The residents who completed surveys had mixed views about activities. Some said there were always enough but others said only sometimes. One of the people we spoke to during the visit said there was not a lot to do but they were quite able, and happy, to occupy themselves. On the day of the visit some residents attended a religious service. Others had very little stimulation and residents who were not able to occupy themselves generally sat in the large lounge falling asleep. The television was on but, because of the size and layout of the lounge, only a few residents were able to see and hear it. Staff we spoke to said there were games and a quiz once a week and an entertainer came in every month. Apart from that there was very little for residents Care Homes for Older People Page 17 of 32 Evidence: with dementia to do. One of the staff who completed a survey commented that there should be more activities and the AQAA indicated that this was an area where the service could improve. Assessments and care plans included information about residents preferences with regard to meals, daily routines and personal care issues. This helped staff to make sure they provided care the way the resident preferred. A relative we spoke to said, When they arrange the care plan they find out what she wants. During the course of the visit we observed staff giving residents choices about day to day issues. One relative said, Mum gets a very personal service and thats what I like. There was open visiting, which helped residents be able to remain in touch with family and friends. Relatives said they were made to feel welcome and said staff kept them up to date with any changes in their relatives health. Some residents went out with their families but there were few opportunities for others to access facilities in the local community. Residents who returned surveys indicated that they always or usually liked the meals and those we spoke to during the visit confirmed this. One said, The meals are good, well cooked, and another told us, Lunch was very nice, it always is. The records of meals showed that people received a varied diet. The cook told us that special diets were catered for and there was information in the kitchen about preparing food for people with swallowing difficulties. The cook had recently done a course about nutrition. Whilst residents did not have any direct input into menu planning, the cook said he was aware of peoples likes and dislikes and used this knowledge to arrange the menus. There was a choice at each meal and residents could have alternatives if they did not like what was on offer. The cook went round each day to ask what residents wanted for lunch but the menu was not on display to remind people. Residents could choose where they wanted to eat but most sat in the dining room. Although it was a large room, tables were set for small groups and the atmosphere was relaxed and social. Residents who needed help were offered it in a sensitive and discreet way. Following a recommendation at the last inspection, residents had a choice of drinks with their meals. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of clear procedures could result in complaints and safeguarding incidents not being handled appropriately. Evidence: There was a summary of the complaints procedure in the service users guide but this did not completely explain the timescales for responding to complaints. A full policy was available but this was not displayed anywhere in the home. All the residents who completed surveys had someone they could speak to informally if they had any concerns but half said they did not know how to make a formal complaint. Staff who returned surveys said they knew what to do if anyone raised concerns with them. There had been no complaints about the home in the past year. Most staff had received recent training in safeguarding adults and the remainder were booked on a course. Staff we spoke to were aware of their responsibility to report suspected abuse or poor practice to the manager or social services. The service had a protection of vulnerable adults procedure for staff to refer to but it was not completely clear about the role of the manager and of social services in investigating abuse. There were no local contact numbers for senior staff to refer to in the absence of the manager. The manager was aware of the procedure to follow and had experience of referring suspected abuse, by a family member, to the adult protection team. Care Homes for Older People Page 19 of 32 Evidence: The manager and staff had recent training in the Mental Capacity Act and how it could affect their practice when caring for people with dementia. The new care records included an initial assessment of the residents capacity to make decisions about day to day issues or more significant events. The manager told us that all residents who had a diagnosis of dementia would be assessed and if necessary referred on for further assessment. She gave a recent example of how she had involved a GP to help to make a decision about hospital treatment, based on the residents best interests. However, there were still residents who were being given medication covertly without evidence that their mental capacity had been assessed, or evidence of consultation about their best interests. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in the environment helped to make the home more comfortable but lack of guarded heaters could present a risk to residents health and safety. Evidence: The AQAA told us there had been some improvements to the environment. The main areas that had been identified during the last inspection had been addressed. For example, there was new furniture in the conservatory and the two small lounges had been redecorated. There were still some areas in need of upgrading, for example, vanity units in some bedrooms were chipped and worn. The manager told us these were to be replaced but there was no action plan to show when the work was scheduled. Most areas were decorated and furnished in a homely style. However, the main lounge/dining room was very large and open. Although attempts had been made to create small groups of chairs, the overall effect was institutional. There was a large TV at one end but it could not be seen or heard from a number of seats in the room. A relative commented that the lounge was a bit open. The manager said she had tried partitioning the room but residents had not liked it. The majority of bedrooms had been furnished with personal pictures and ornaments to make the environment familiar and comfortable for residents. Those we spoke to said Care Homes for Older People Page 21 of 32 Evidence: they were happy with their bedrooms. One resident told us they had asked to move downstairs so that they could watch the bird tables more closely. The secure, courtyard garden had recently been repaved and new flower beds put in. It offered a pleasant place for residents to walk or sit. One relative told us that their mother, Loves the courtyard; she had her dinner out there the other day. The AQAA told us that new radiator covers, with rounded edges to reduce the risk of injury, had been put on all the radiators. However, we noted that there were a number of unguarded wall heaters, which could cause burns if a resident fell against them. The manager told us that these were due to be replaced before the winter months. As we required following the last inspection, the fan had been repaired in the conservatory and during our visit we noted that the smoke was contained in this area. Signs on bedroom doors had also been replaced as we required. At the time of the visit the home was clean and tidy. Residents who completed surveys indicated that it was always like that. Bathrooms and toilets contained liquid soap and disposable towels. An infection control training course was booked and the manager told us that all staff would be attending. The laundry was adequately equipped for the size of the home. We did not hear any negative comments about the laundry service and on the day of the visit the residents clothing looked to be well cared for. On the day of our visit the laundry was tidy and organised. However, there were no disposable gloves or soap and paper towels, which could be an indication that the laundry staff were not following infection control procedures when handling dirty laundry. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient staff with basic training, to meet the needs of the residents. Evidence: Since we raised concerns about nighttime staffing during our last inspection, the numbers had been increased to three. The manager said that this was sufficient for the number of people who needed help from two staff, and the layout of the home. Residents who completed surveys had mixed views about whether staff were available when they needed them. Most people said they usually were but one said only sometimes. Some of the residents we spoke to made positive comments about the staff team. One said, They are lovely girls, very good. Another told us that staff helped them to settle in when they first came to the home. Relatives also praised the staff and one told us that staff had coped very well with their relatives complex behaviour. We looked at two staff files. One included evidence of all the required pre-employment checks. The other member of staff had been introduced by a recruitment agency. None of the required documents were on file to evidence that they had appropriate checks to ensure they were fit to work with residents. New staff had an initial induction to the home, which included key policies and Care Homes for Older People Page 23 of 32 Evidence: emergency procedures. They went on to complete an induction workbook, which covered all the topics of the common induction standards. The manager told us that this was mostly self taught, which meant that staff had limited opportunities to discuss the content of the training. There were written assessments to evidence that staff had understood the topics but there was no formal assessment of practice to ensure that staff were able to transfer the theory to practice. There had been some improvements in training since the last inspection. The manager forwarded on the central training record after the inspection. This showed that there were some gaps in the mandatory training such as manual handling. However, we were shown a training plan for the next few months, which included most of the health and safety topics. The manager told us that all staff would be attending the courses. Staff who completed surveys indicated that they received training that was appropriate to their work. Dementia care awareness training was booked and a more in-depth course was to follow. The manager was undertaking a degree in dementia care. The manager was trying to source other relevant training in topics such as Diabetes and Parkinsons disease. The AQAA told us that less than half of the care staff were trained to NVQ level 2 but the manager told us there were some staff undertaking the course at the time of the visit. Following a requirement at the last inspection the manager had put into place a schedule for staff supervision. The records showed that the focus for the first sessions had been the new care plan documents. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of systems for monitoring and improving the quality of the service meant that the home was not always run in the best interests of the residents. Evidence: Since the home received the rating of 0* poor after the last key inspection, the registered manager put into place a number of initiatives to bring about improvements in the quality of the service. She also recognised that further developments were needed. There were limited systems for evaluating the quality of the service. The results of the last annual survey had been collated and communicated to relatives. However, there were no internal audits to indicate whether the home was running well and in accordance with best practice. The AQQA showed areas where the manager planned to improve but these were not included in a formal development plan. There were no priorities or timescales for action. Since the last inspection the area manager had been undertaking monthly unannounced visits to the home to monitor the service and Care Homes for Older People Page 25 of 32 Evidence: support the manager. There were brief reports of the visits but no areas for improvement had been identified. The systems for handling residents money remain safe. We checked records and balances and found them to be correct. At the last inspection we made a requirement relating to the storage of potentially hazardous items. At this visit all medication, cleaning chemicals, denture cleaner and other potentially hazardous substances were locked away for residents safety. The fire risk assessment had been reviewed and the new recommendations had been actioned. Fire safety training was up to date and staff had regular practice drills. Fire safety equipment was serviced and tested regularly. Servicing and maintenance of other equipment and installations was up to date. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 Full and accurate records 29/05/2009 must be kept for the administration of medicines including those prescribed with variable doses and those prescribed for external application To ensure staff follow safe procedures for medicine administration and protect the health and welfare of people 2 9 13 Peoples mental capacity must be assessed to establish if they are able to consent to treatment and that the medicines administered covertly are being given to them in their best interests. To protect the health and welfare of people with dementia 29/05/2009 Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 The use of bedrails must be risk assessed and kept under review. To protect the health, safety and welfare of residents. 31/08/2009 2 8 13 Unexplained injuries must be followed up and appropriate action taken. To protect the health and safety of residents. 31/08/2009 3 9 13 Peoples mental capacity must be assessed to establish if they are able to consent to treatment and that the medicines administered covertly are being given to them in their best interests To protect the health and welfare of people with dementia. 31/08/2009 4 9 13 Full and accurate records must be kept for the 31/08/2009 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action administration of medicines including those prescribed with variable doses and those prescribed for external application. To ensure staff follow safe procedures for medicine administration and protect the health and welfare of people. 5 12 16 Residents must have individual care plans to direct staff how to support them to meet their social and recreational needs. This is in order to promote residents mental health and well-being 6 16 22 Residents and /or their 31/08/2009 representative must have access to a clear complaints procedure that is in a suitable format to meet their needs. This is to ensure that peoples right to complain is protected. 7 19 13 Unguarded wall heaters 30/09/2009 must be assessed to identify and reduce any risks they pose to residents who may fall against them. 30/09/2009 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to protect residents health and safety. 8 29 19 The manager must obtain and retain copies of preemployment checks and all schedule 2 documents in respect of staff introduced by a recruitment agency. This is to help to ensure that the member of staff is fit to work with residents. 9 33 24 The system for evaluating the quality of care must be further developed. This is to ensure that the home is providing a safe, good quality service that meets the needs of the residents. 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 31/07/2009 30/09/2009 1 2 8 9 Records of falls should be audited to identify any patterns or trends and take appropriate action to reduce risks. Handwritten entries on MAR charts should be doubled signed to evidence they have been checked to reduce the risk of transcribing errors. To ensure there is a full audit trail, stocks of medication carried over from the last monthly cycle should be recorded. 3 9 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 10 Residents or their representatives should be consulted with regard to putting privacy blinds or curtains up in the rooms that are overlooked. The adult protection procedure should clearly set out the responsibilities of staff to report any suspected or actual abuse to the adult protection team in accordance with the local social services guidance. The manager should carry out an audit of the environment to identify all areas in need of redecoration and renewal then draw up a plan, with realistic timescales, to address any shortfalls. To enable infection control procedures to be followed, there should be disposable gloves, soap and disposable towels for use in the laundry. The manager should ensure that staff who need refresher training in health and safety topics are booked onto the upcoming courses. The way new staff complete induction training should be reviewed so that staff have an identified mentor to assist them through the training programme. 5 18 6 19 7 26 8 30 9 30 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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