Inspection on 28/06/10 for Churchfield Court Care Home

This inspection was carried out on 28th June 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 04/09/2010.

Key inspection report Care homes for older people Name: Address: Churchfield Court Care Home Millers Court Radford Nottingham Notts NG7 3DP     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Linda Hirst     Date: 2 8 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Churchfield Court Care Home Millers Court Radford Nottingham Notts NG7 3DP 01159424051 01159790074 churchfieldradford@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Trinity Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 40 The registered person may provide the following categories of service only: Care home with nursing Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia: Code DE Mental Disorder, excluding learning disability or dementia: Code MD Date of last inspection Brief description of the care home 40 40 Over 65 0 0 Care Homes for Older People Page 4 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 focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We also reviewed all of the information we have received about the home since we registered it and we considered this in planning the visit and deciding what areas to look at. We sent out surveys to people living at the home and to staff to get their views on the service being provided. Care Homes for Older People Page 5 of 34 The main method of inspection we use is called case tracking which involves us choosing three people who live at the service and looking at the quality of the care they receive by, observation, reading their records and asking staff about their needs. Part of this inspection looked at the quality of care people with dementia experience when living at Churchfield Court. Because we are unable to communicate effectively with all of the people with dementia, we have used a formal way to observe people in this inspection to help us understand their experiences of life at the service. We call this, the Short Observational Framework for Inspection (SOFI). This involved observing 5 people who live at the service over two hours and recording their experiences at regular intervals. We made judgements about their state of well being, and how they interacted with staff members, other people who use services, and the environment. We discreetly observed people in the dining room, during the lunchtime period. Some of the people living at the home are minority ethnic communities and we case tracked a person from a minority ethnic group to make sure their needs are being considered and provided for at the service. The staff team come from a wide variety of backgrounds and experiences. We spoke with two members of staff to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. Care Homes for Older People Page 6 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The way staff interact with people who live at the service could be much better, both in terms of the frequency they do this and in the quality. They could be much better at showing people respect and in treating them with dignity. They could also show greater respect for peoples privacy and take more care to make sure information about them is discussed confidentially. The arrangements for making sure people are occupied and entertained when the activity organiser is not on shift could be much better to make sure people do not get bored. We found the staff could have a better understanding of peoples ability (capacity) to make decisions about their lives and make sure they act legally by not restricting them unless this has been recorded and agreed. We found the service could be much better at providing a culturally appropriate diet for people in line with their preferences. They could also provide adequate quantities of food so people can have their first choice of food. This would mean they are more likely to eat and maintain good health. The service could be better at making sure complaints and concerns are always written down and that there is a full report on what they have done and the outcomes of complaints and safeguarding. They could also be more careful at making sure they notify us of all safeguarding incidents. We found that locks on bedroom doors could improve peoples privacy and make sure their dignity is not compromised by people entering when they have not been invited. Care Homes for Older People Page 7 of 34 The home could be much cleaner to make sure infections do not spread between people living at the service and staff. The staffing levels do not appear to be sufficient to meet the needs of people promptly. The acting manager needs to make sure we can see all of the records we need when we inspect so we can monitor the quality of the service. She also needs to make sure that all of the records and documents are in place on staff files so she can be assured that staff are suitable to work with vulnerable people. The acting manager needs to apply to become registered and she needs to take decisive action to make sure the improvements needed are achieved and sustained. 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 8 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 9 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who want to live at the service have their needs fully assessed before admission to be sure that these can be met. Evidence: We looked at the care plans of four of the people who live at the service and found that all of them have had a pre admission assessment, including an assessment by their Social Worker to check that their needs can be met at the service. The service also do their own pre admission assessment. Staff we spoke with told us, the most important thing is that their care needs are met and time is given. We spoke with a relative of a person living at the service who said, I like it here, I think my (relative) gets good care. Care Homes for Older People Page 10 of 34 Evidence: During our observation we saw that the people living at the service were all within the category of registration, though there are a high number of people who are resistant to help and therefore need a lot of staff time. The service need to take account of this when planning new admissions to make sure the staffing levels match the dependency needs of people who live at the service. Intermediate care is not provided at the service and this standard is not applicable. Care Homes for Older People Page 11 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 have their healthcare needs met. Staff are not following care plans and do not interact and communicate with people living at the service effectively. This means their personal care needs are not being met and they are not being treated in a respectful way which preserves their dignity. Evidence: We looked at several care plans; we found these contain good information. Although the plans do tend to be task focused, they also concentrate on each individual to ensure their personal preferences are taken into consideration when delivering care. We found the plans are being reviewed regularly and they reflect the current needs of people who live at the service. We did find, however that the plans could provide more guidance to staff in some circumstances, (E.g. in advising staff how Dementia affects each person in their everyday life, in highlighting how staff should deal with people whose behaviour can challenge.) Care Homes for Older People Page 12 of 34 Evidence: The staff we spoke gave us mixed views about how accessible care plans are. One told us, we can access care plans but it depends because they are confidential we have to ask permission,where another told us they are readily available to staff. The staff we spoke with told us they feel they manage behaviour well, when people are resistant or agitated we need to show patience it may be that they are in a bad mood we try all possible means to calm them down, and let them know what we are doing. If they refuse we leave them to calm down otherwise it would wind them up more. They also showed in interviews with us that they understand the needs of people we case tracked. However, our observations on the day show they are not putting this knowledge into practice. During our observations we saw many examples of people not following plans of care, we saw a person becoming angry as staff were not giving him time and space and this resulted in the person becoming more and more agitated with staff. We observed a person who was agitated and distressed talking to a staff member, who did not turn towards them, but spoke with their back to the person. This resulted in the person seeking attention from staff by trying to get to their feet, which succeed in gaining staff assistance as they are at risk of falling. We found clear evidence that peoples healthcare needs are being assessed and treated appropriately, though in some cases we found delays with accessing chiropody. We found evidence that people are assessed with plans in place to maintain continence, mobility, prevent pressure areas and falls and to maintain nutrition. We found evidence that people are referred to the Doctor appropriately, and some have input from Community Nurses, Dieticians, Physiotherapists, Occupational Therapists and chiropodists. Staff we spoke with told us, I have done infection control training and we have enough protective equipment if we run out they order more. I have also done a manual handling trainers course. I am now the in-house trainer, and it feels like I have achieved a lot and it has boosted my morale. If I am working on the floor and I see anybody doing anything wrong I do stop them and correct their actions. During our observations we noticed that people are being moved and handled safely, though infection control could be much better (see OP16.) We looked at the arrangements for medication to check that these are safe and that people receive their tablets as prescribed by their Doctor. We found that medication is stored securely and appropriately, though the record of the temperature in the medication room gives cause for concern as these have been consistently over 25 Care Homes for Older People Page 13 of 34 Evidence: degrees Celsius for a week. This effectively means some medication cannot be stored at a temperature indicated by the manufacturer. Steps need to be taken to address this. The Medication Administration Records are fully completed and well maintained, there is evidence that antibiotics have been given as prescribed and courses have been completed. We found clear evidence of consultation with the Doctor in terms of medication and also the Dementia Outreach Team. Staff and people who live at the service did not make any comments to us about medication. We spoke with a member of staff who is a dignity champion, I think the staff are working well to improve dignity for people using the service their rights and choices, quality of life and that people are happy and where they want to be. I feel that staff offer good quality and if necessary I check upon staff and correct them as needed. However, we found from our observations that there is a real issue in respect of staff interactions with people living at the service, both in terms of quality (the vast majority of interactions we witnessed were around practical matters and to help with tasks,) and quantity, (we found that in three quarters of the 5 minute timeframes, the people we observed had no interaction at all with staff.) When we analysed this observational information we also found that some people we observed have hardly any interaction with the staff, (in one case staff engaged with a person only once in two hours and in another only twice. We compared this with another person who is more able to express their needs and seek staff help and conversation whom staff interacted with in 16 timeframes.) This disparity needs to be addressed. Our observations show that there is a failure to communicate effectively with people who have Dementia. For example, a member of staff was showing a person two plates of food to help them make a choice at lunchtime, but because the person was distracted and could not concentrate for long periods this was taking some time. The staff member was becoming visibly agitated at the time it was taking to make a choice, and the pitch of their voice changed and was becoming less patient. We also observed a person being assisted to move using a hoist. The staff did not communicate effectively with the person and lifted her skirt without giving her any indication they would do this to put the sling in place. She was visibly distressed at this and tried to put her skirt down saying, no, no get off, as she did not understand what was happening. This potentially compromises the dignity of people living at the service. Care Homes for Older People Page 14 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not live flexible lifestyles in accordance with their needs, preferences and cultural requirements. Evidence: We looked at the records and found that care plans for activities of daily living are in place which reflect peoples likes and dislikes. We found some evidence that people have been involved in activities such as games and music, and we saw photographic evidence of people taking part in activities. Staff we spoke with told us, There are games, and a musician came last week we had a barbecue, dancing, church visits, taken them out to the park. The activities lady comes up to do the programme with residents. The activities organiser was not working on the day we visited and there were no activities being provided during our observations. The television and the radio were on at the same time in the upstairs lounge, meaning people could not concentrate on either effectively. People commented during our observation to each other that they were bored. Care Homes for Older People Page 15 of 34 Evidence: When we looked at the information we collected from our observation we saw some people engaged a lot with staff or others living at the service, but two people had nothing to do for well over half of the time frames, and one who was engaged for half the time was doing a task such as eating, drinking or walking rather than being purposefully occupied. Two people slept for most of the time. We saw some visitors during our observation who sat with their family/friends. One person told us they are very satisfied with the service, I have no complaints about it. Those we saw appear to have a good rapport with the staff, although the staff could be more discreet when discussing confidential information about people and make sure they either lower their voice or take the relative to a more private area. Staff we spoke with told us, The most important thing is for people to be happy, to speak clearly in a language they understand, that they receive the care they need in a supporting way and that the family are supported and made happy and people are given security. The care plans we saw mainly reflect peoples preferences and likes and dislikes, including their personal routines. We found that the staff understanding of the Mental Capacity Act and when to undertake an assessment could be better. For example one person has a care plan in place which states that the person should only be resuscitated if the quality of life will be good. There is no assessment of the persons capacity to make this decision for themselves, no advance directive and the guidelines from the Resuscitation Council have not been followed. We have sent this information to the company for future reference. The service have made referrals under the Deprivation of Liberty Safeguards in cases where medication is being given covertly and where there are restrictions on people for health reasons. These referrals have not necessitated an authorisation but the correct process has been followed. However, we witnessed staff physically preventing a person living at the service from accessing the lift when this is not agreed as part of the care plan, care is needed to ensure people are not being restricted when this has not been assessed as necessary. Staff we spoke with told us, my understanding of the Mental Capacity Act is that people can do what they want it is their home. We are just here to help them we cant stop them from doing anything. We are just going to do the deprivation of liberty training but I have an understanding of this. Another told us, There are those people that can make their own choices if people cant make choices, for instance at dinner time we offer them two choices so they can pick or when getting dressed, two dresses which they can point to. Care Homes for Older People Page 16 of 34 Evidence: During our observation we saw staff offering choices to people, and in the main their choices were respected. They do make use of visual prompts (See OP10) but this is not always done effectively. The service shares catering with the sister home on the same site. Food is cooked there and brought across in heated trolleys. There has been a recent complaint about the quantities of food provided to this service and this was partially substantiated and an action plan put in place to prevent this happening again. We observed lunch and found this to be poorly organised. People were taken to the dining room an hour before they started eating, the tables were not set with any condiments and people were waiting for such a long time that they were pulling table cloths and napkins off. People made comments to each other during our observation, you wait all night for your dinner, another person said, Im starving, to which staff responded, I told you I was bringing it, you just have to wait. The atmosphere between staff and people living at the service was observed to be very tense, and staff were very busy. There are people from minority ethnic communities living at the service, but they were not offered a special diet. Staff we spoke with told us, the meals are okay there are two choices. But with the (special dietary requirements) the family bring this in because the kitchen do not cook it. We raised this with the Quality Manager for her to take action. There were two choices for lunch, one of which ran out before everyone was served, so one person had to have some of the alternative option to make sure they had sufficient to eat. We also noticed that the fridges on the units had minimal amounts of food in them, and there was nothing to make a savoury snack for people if they requested this. We observed staff offering drinks to people throughout the day and we saw some positive interactions, with staff being careful to protect peoples clothes and encourage them to take sufficient fluid. Care Homes for Older People Page 17 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples concerns and complaints may not be recorded in line with the complaints procedure but where they are these are responded to. People are not always safeguarded by staff who follow the correct procedures. Evidence: The complaints procedure is displayed in the service. We have had two complaints made directly to us since the service was registered; one concerning the quantity of food supplied to people living at the Court which was partially substantiated and another concerning the quality of care being provided, lack of activities, staffing levels and issues of dignity. These allegations were partially substantiated. The service have also received four other complaints, one of which was referred to safeguarding. We found that although complaints are noted, there is a lack of information in regard to the evidence found during the investigation and responses given. This needs to be tightened up to ensure there is clear evidence that complaints are being responded to properly. Staff we spoke with told us, If I received a complaint I would tell the manager and record this. However, another member of staff said, it depends on what the complaint is about if I can deal with it I would if not I would report this. This may mean that not all complaints and concerns are being recorded and looked into appropriately. Care Homes for Older People Page 18 of 34 Evidence: A relative we spoke with told us, I have no complaints, I would make them if I did. There is a copy of the local safeguarding procedures at the service, in addition to the company safeguarding policy and procedure. We have been made aware of four safeguarding allegations since the service was registered, two of these were not notified to us as they should have been by the former acting manager. One concerned abuse between people living at the service, one was about poor care practice and neglect and two others were allegations against staff. The correct safeguarding procedures were followed in all cases. The records held at the service about these issues is minimal, but all of these occurred when the former acting manager was in post. We also found evidence of one safeguarding alert which has now been resolved, but has not been written in the safeguarding file despite information being available within the plan of care. These processes need tightening up. Staff we spoke with told us, If I witnessed any form of abuse, I would go and report it. If they did not act I would go higher. I have not seen anything like that happen here. Another said, if I saw abuse I would talk to the resident then talk to the nurse and report this. I know about the safeguarding team the contact number is in the office. Where we did not witness any abusive practice as such, we do have concerns about ability of staff to engage effectively with people and maintain their dignity (see OP10.) We also saw some examples of poor practice during our observation, such as staff lying to people to get them to do what they wanted, (come with me and Ill take you home.) Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained but it is not kept clean and hygienic, placing staff and people using the service at risk of cross infection. Evidence: We did a partial tour of the accommodation to make sure it is clean, well maintained, homely and comfortable. We found that the service is generally well maintained, the ground floor bathroom needs attention and this issue has been outstanding for some time. We also found that not all of the bedrooms have a lock on the door. Given that this is a service for people who have Dementia who may walk into other peoples bedrooms this potentially compromises the privacy and dignity of people living at the service. It also means their belongings may not be secure. We found that the home is not clean, hygienic and well maintained. We found sticky and dirty residue on an electronic access switch which is used by staff, people living at the service and visitors. It was there for well over an hour without being cleaned, the kitchen floor on the first floor was sticky, handrails were also sticky to the touch. During our observation, we noticed that staff do not routinely disinfect chairs when people have been incontinent. Care Homes for Older People Page 20 of 34 Evidence: The Quality Manager told us that a new housekeeper has been employed and is being inducted at the moment. Staff we spoke with told us that they have had infection control training and they told us they have sufficient protective equipment available. Care Homes for Older People Page 21 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are insufficient staff available to meet peoples needs in a prompt manner, and the recruitment process is not sufficiently robust to ensure that people are protected from people who may be unsuitable to work with them. Evidence: We looked at the staff rota and found that there are usually 8 care staff on each day time shift and two nurses. The nights are staffed by 1 nurse and 4 carers. These staffing levels seem very high on paper. The staff we spoke with told us, (in terms of staffing levels and whether these are sufficient,) it depends as some people need one-to-one care then we need more staff. There are 4 staff to 18 service users downstairs; one person is on one-to-one care which leaves three staff for 18 service users. We have a lot of people who wander, need assistance and feeding. They still have their care needs met but it will improve the standard of care if we have more staff on shift, as by the end of the day we are all too tired. Have tried to talk to the manager she is going to look into this. During our observations we saw that people who live at the service have very high levels of dependency, not only physically (eg people who need assistance to move, people who need assistance to maintain their continence, nutrition and personal care) but also people need a high level of emotional and psychological support. All of these Care Homes for Older People Page 22 of 34 Evidence: needs require high levels of staff support. We noticed that the care staff provide is often reactive rather than proactive. We saw three situations where people needed help to change their clothes. In one case a person waited for 45 minutes in wet clothes and we had to ask staff to take the person and change them. In another, a relative had to come and ask staff to help change a person. There were significant periods of time during our observation where there was no staff interaction with people living at the service. When we sat in the upstairs lounge a member of staff only came in once in an hour, downstairs, there was no interaction with people in 46 out of 75 timeframes, well over half the time. People were often left with minimal input and entertainment, other than the television. During our visit to the service we asked for the training records and the information on the number of care staff who have achieved National Vocational Qualification level 2 or above. The Quality Manager informed us that these would be sent by email, but we have not received this information. We are unable, therefore to assess these standards. We looked at three staff files to check that people have had all of the necessary information and documentation required by Law to show they are suitable to work with vulnerable people. In the main, these were satisfactory, but we found one person has had a Independent Safeguarding Authority First check but has no Criminal Records Bureau check. We advised the Quality Manager that the person should not be working unsupervised on shift without this document, she assured us she would chase this. The same person had only got one written reference and a telephone reference on file. There must be two written references, and telephone references should always be backed up in writing. The Quality Manager also said she would chase this matter. The staff we spoke with did not have any comments to make on employment processes. Care Homes for Older People Page 23 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. Significant improvements are needed to ensure the home is being effectively managed and runs in a way which ensures the safety of people who live there. Evidence: A new acting manager is in post in the service, we have no evidence that she has applied to become registered; although the Service Quality Advisor tells us she has. As can be seen from this report there are a number of significant concerns which need management oversight and action if the service is to run in the best interests of the people who live there; (OP10, OP12, OP14, OP15, OP16, OP18, OP19, OP26, OP27, OP29.) Staff we spoke with told us, We had supervisions with the manager these are fine they reminded us of things to do refresh our minds; if unhappy we can go to the manager as she is approachable. Care Homes for Older People Page 24 of 34 Evidence: We looked at recent audits of the service, there has been a lot of input from the Service Quality Advisors. Audits have been completed on medication, Health and Safety and a full assessment audit has also been completed. These are honest appraisals of the service with clear action plans. The Quality Manager has told us the service aim to have sustainable improvement. Staff did not make any comments to us on this area. We were unable to access the financial records of people living at the service as the administrator was on leave. We have already made a requirement about the availability of records (see OP28 and 30.) All health and safety tests are being conducted as required. Care Homes for Older People Page 25 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 26 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 7 12 Care staff must make sure they deliver care in line with the plan of care To make sure people receive help in a consistent way. 31/08/2010 2 9 13 Action must be taken to 31/08/2010 make sure the temperature of the medication room does not exceed 25 degrees Celcius To ensure medication is stored in line with the manufacturers instructions and maintains its efficacy 3 10 18 Staff must be properly supervised and their performance managed To ensure that they treat people with respect and dignity at all times. 31/08/2010 4 10 12 Staff must engage with all of 31/08/2010 the people living at the service appropriately Care Homes for Older People Page 27 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To make sure their needs are properly met. 5 12 16 Steps must be taken to make sure people are provided with activities in line with their wishes and preferences, even if the activity organiser is not working To ensure people are occupied and entertained. 6 13 12 Staff must make sure that they show due respect for the confidentiality of people living at the service To make sure their privacy is respected. 7 14 12 Staff must not restrict 13/08/2010 peoples liberty unless this is care planned or authorised as needed by a Deprivation of Liberty Safeguard To ensure peoples rights and choices are upheld and respected. 8 14 18 Staff must be given training and information on the Mental Capacity Act and the Deprivation of Liberty Safeguards To make sure they are acting legally and upholding 08/10/2010 13/08/2010 31/08/2010 Care Homes for Older People Page 28 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action peoples right to make their own decisions where possible. 9 14 12 Peoples capacity must always be assessed before any decisions are made in respect of resuscitation, and the Resuscitation Councils guidelines followed To make sure that people have the right to life saving treatment where appropriate. 10 15 16 There must be a sufficient 30/07/2010 quantity of food provided for the people living at the service To make sure people have enough to eat and are provided with their preferred option. 11 15 12 Steps must be taken to make sure a culturally appropriate diet is available. To make sure the cultural needs and preferences of people living at the service are catered for. 12 16 22 All concerns and complaints 31/08/2010 made to staff must be reported, fully recorded, and details must be kept of their investigation, outcome and 31/08/2010 31/08/2010 Care Homes for Older People Page 29 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action action taken to prevent reoccurrence at the service. To ensure peoples concerns and complaints are responded to appropriately. 13 18 17 There must be a full record of any safeguarding allegations, details of who is investigating and outcomes To ensure the local safeguarding procedures are being followed and lessons can be learned. 14 18 37 All safeguarding allegations must be notified to us as soon as possible in writing. To enable proper monitoring and risk assessment of the service and to ensure people are safe. 15 19 23 The unused ground floor 31/01/2011 bathroom must be upgraded and made safe for use. To make sure there are sufficient, appropriate and safe bathing facilities for people living at the service. 16 19 23 Bedrooms must be able to be secured 08/10/2010 30/07/2010 30/07/2010 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure the privacy, dignity and security of peoples belongings can be maintained. 17 26 13 The home must be clean and 13/08/2010 measures taken. To effectively prevent cross infection 18 27 18 The dependency levels of 30/09/2010 people living at the service must be kept under constant review, along with the staffing levels which are required to meet these needs To ensure that people receive help and interaction as soon as possible and do not wait for long periods of time without assistance. 19 28 17 Arrangements must be in place to make sure that records we require to see are available for inspection when requested To meet legal requirements and enable appropriate monitoring of the service. 20 29 19 People must work under direct supervision until their full Criminal Records Bureau check has been received. 30/07/2010 30/07/2010 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure the safety of the vulnerable people in your care 21 29 19 All staff must have two written references. To ensure they are suitable to work with vulnerable people. 22 31 9 The management of the service must improve To ensure the service runs in the best interests of people living there. 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 31/08/2010 30/09/2010 1 3 When planning new admissions, consideration should be given to the needs of the existing residents, the staffing levels and the overall dependency needs of people to make sure that peoples needs can be met appropriately at the service. Care staff must be given access to care plans when they need them so they can access key information and deliver care effectively. Care plans should provide sufficient guidance to staff so they can understand peoples needs and have a range of ways to respond to these. Consider the deployment of staff at lunchtime to make sure people are not waiting for significant amounts of time for food and drinks. There should be adequate quantities of food available in the Page 32 of 34 2 7 3 7 4 15 5 15 Care Homes for Older People 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 unit kitchens to enable staff to make snacks for people if they want one. 6 7 15 18 Staff should not take people to the dining room excessively early unless this is their wish. Staff should not use deception to get people to do what they want them to do. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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. Re-publishing this information is in breach of the terms of use of that website. 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