Inspection on 07/11/08 for Clare House

This inspection was carried out on 7th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Clare House 29/10/07

Clare House 13/12/06

Clare House 19/04/06

Clare House 27/09/05

Clare House 19/04/05

Clare House 30/11/04

Clare House 02/06/04

Clare House 01/03/04

Clare House 16/04/03

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Clare House Whittlebury Road Silverstone Northants NN12 8UD     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ann Wiseman     Date: 0 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Clare House Whittlebury Road Silverstone Northants NN12 8UD 01327857202 01327858976 apopat@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Clarex Limited care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 1 named person may be accommodated over the age of 62 years No one in the category of DE (E) may be admitted to the home if there are already 5 service users in this category accommodated within the home. To limit the number of service users in the categories DE (E) Date of last inspection Brief description of the care home Clare House is a detached property situated in the village of Silverstone to the south of Northampton and is set back from the road in pleasant gardens. The home is registered to provide personal care for up to 25 residents over the age of 65 years, including up to five people with a diagnosis of dementia. The home has several communal areas that are attractive and comfortable and bedrooms are over three floors with a passenger lift for access to the first floor. All bedrooms are single rooms. The current fees range from £380.00 for a standard bedroom to £520.00 per week for a large bedroom with en-suite facilities. A chiropody service is included in the weekly Care Homes for Older People Page 4 of 38 Over 65 5 25 25 0 0 0 Brief description of the care home fee, hairdressing is provided at an additional cost. The registered provider is Mr Atul Popat; the position of registered manager is vacant. Care Homes for Older People Page 5 of 38 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: This home does not have a registered manager at the moment and the provider is running the home. This was an unannounced inspection; we arrived at 8.30am in the morning and left soon after 6pm. The provider was not at the home when we arrived but the care staff that were on duty showed us around the home and answered our questions, which they did in an open and helpful manner. When the provider arrived he facilitated the rest of the day. Whatever files and documents we asked to see were produced. During the day we had a look around the home and talked to some of the staff and the people living there. Care Homes for Older People Page 6 of 38 We looked at information belonging to four people and all of the of the staff files. We also assessed some of the homes policies and procedures and sampled a random selection of the health and safety files and records. Before the inspection the manager sent us the Annual Quality Assurance Assessment (AQAA) he had completed. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. The AQAA would benefit from being more detailed and it needs to include examples to back up the statements made in it. For example when asked what they could do better the provider said, There is always room for improvement. This sort of answer doesnt give us an opportunity to judge whether the provider recognises the areas of his service that needs improvement or that he knows how an improvement can be made. We had sent surveys to the home for distribution amongst the people in the home, their relatives and the staff. Unfortunately at the time of writing this report we have not had any of them returned. So the only feedback we received was from the people who were in the home during our visit. Clare House was clean and tidy and the atmosphere was friendly and congenial, interaction between the staff and the people living in the home was observed to be friendly and open. When talking about the people they did so in a supportive and respectful manner. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 38 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 38 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 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information to help them make an informed choice about the home, but it needs to be reviewed and written in a more accessible way. Assessments are usually carried out before people move into the home, we found one person did not have one. People are able to visit the home to assure themselves the home can meet their needs. This home does not offer intermediate care. Evidence: The guide would be made more attractive to potential customers if it contained photographs of the home, information about the surrounding area, and an introduction to some of the staff and the amenities on offer at the home. Neither of the documents were easily available for people to see, they would have to ask the provider for a copy. Care Homes for Older People Page 11 of 38 Evidence: It would be an improvement if a copy was given to everyone thinking of moving into the home and if it was made available along with the most recent report in the entrance lobby as promised by the provider during the last inspection. During this inspection we had a look at four peoples files so that we could check that proper procedures were used in admitting them into the home and while they were being cared for. Three of the four files we examined, contained an assessment of need that had been done by the provider before people had moved into the home. The assessments had collected a lot of important information about peoples needs, but in a very factual way. The provider needs to develop a more person centred way to carryout the assessment and to include the person and their families so that the outcome would be a holistic picture of the person, their needs, hopes and aspirations. The provider told us that he encourages people thinking of moving into the home to visit with their relatives and assesses whether the home can meet their needs while they are there, he said that he asks anyone while they are looking around to consider carefully if they feel the home is right for them. However people are not told that the home will be able to meet their individual needs in writing. The proprietor should consider including this reassurance in the contract he gives people when they move in. One person admitted into the home did not have a formal assessment carried out. They are well known to the provider so he didnt feel that he needed to do one on this occasion. Any person who is admitted into a care home must be assessed to make sure that the staff have the skills and capabilities to care for them properly. This home does not offer intermediate care. Care Homes for Older People Page 12 of 38 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. Care plans are in place but should be more detailed and done in a more person centred way. Healthcare needs are met and medication is managed as required. People say they are treated in a respectful way but the way that personal information is recorded and managed suggests otherwise. Evidence: Individual care plans are written in a format more usually found in a nursing environment and are factually written and task lead. Like the assessments they need to be person centred. More information should be gathered that allows staff to associate the person in their care as someone who has lived a full and varied life with the same fears, hopes and aspirations as they have. By doing this cares will find it easier to empathise with them, which will lead to people being treated as individuals and offered more choice about their lives. One of the care plans we saw used inappropriate language to describe someones Care Homes for Older People Page 13 of 38 Evidence: character and challenging behaviour. Having mentioned the likelihood of disruptive behaviour the care plan didnt go on to elaborate or explain what would make that person upset or how to help them calm down again. Care must be taken while writing anything referring to people that a true and full picture of them is reflected and that it is not overloaded with negative comments. Describing someone in derogatory terms does not promote respect in the reader. Under the freedom of information act people are allowed access to their own records and it would be very upsetting to realise that carers, who on the face of it are friendly and supportive, actually have no respect for you and feel that it is alright to describe people in a way they wouldnt repeat in front of them. Behaviour management plans should be used to clearly describe what may cause someone to display challenging behaviour, what steps can be taken to avoid it, how they will behave when they are upset and what is the best way to help people calm down and regain control. There should also be a system in place to record when incidents occur and how they were managed. We found that one person we had chosen to follow did not have a care plan, staff were expected to gather information on them through their care notes. Also, as we checked peoples files, it became apparent that the care notes are only written if there is something that staff feel it is necessary to record. Everyday events are passed on during handover at the change of shift. This does not help in continuity of care, as things get forgotten and staff who are on holiday or rest days have no way of finding out what has happened while they were away. It will be required that care notes are completed at the end of every shift so that staff who are not present for handover will be able to catch up on what has been happening in the home in their absence. Care notes and other personal information was kept on the same counter in the dinning room as the clean laundry, which was set out in piles so that people could collect in after breakfast. This means that everyone had access to peoples personal records. This is not acceptable as people seeing that their personal files are left laying around will have little confidence that their privacy will be upheld or respected. Records show that peoples health needs are met, doctors visits are recorded and people are referred for specialist medical care when needed. Peoples files also show that they have opportunities to see dentists, opticians etc. when they need to. Care Homes for Older People Page 14 of 38 Evidence: We examined the medication, its storage, management and its records. We found that is dispensed and kept as required and there were no mistakes or gaps in the records. It is stored in a locked cabinet that is secured to the wall in a room that is kept locked when not in use. The home is waiting for the delivery of a medication trolley, this will cut down the time that staff take to complete the round by saving them having to keep returning to the medication cupboard. We spoke to several people while we were in their home and they told us that the staff treated them well and were kind to them. One person said, The girls are so good to me, I dont know how I would manage without them. another who was getting ready for a bath said about the staff, I love this time, I get to have them to myself for a while. Care Homes for Older People Page 15 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People find that the home matches their expectations and are able to maintain contact with family and friends. They are encouraged to make some choices in their day-today life, but they could be given more choice in what they have to eat and how the menu is prepared. Food is well cooked and people say they enjoy their meals. Evidence: People are asked to consider whether the home matches their expectations when they visit the home. The home has an activities coordinator who works on weekdays and there is a program of activities displayed on the notice board. People we spoke to said they were happy with the activities they were offered. There are several areas in the home where people can sit if they dont want to take part in the group activities or listen to the television and there is a library of books for people to borrow. We observed the activities coordinator visiting people individually, including those who stayed in their bedrooms. We also saw staff sitting and chatting to people during our visit. There are several table top activities, such as puzzles and board games, stored in the Care Homes for Older People Page 16 of 38 Evidence: dinning room that people can take away to do. A church service is held at the home monthly and the proprietor assured us that if anyone wanted to attend a different faith service it would be arranged. A notice in the entrance lobby says that visitors are welcome at all times and we saw visitors come and go throughout the day. The dinning room is a large, bright and airy room that is attractively decorated. The dinning chairs are sturdy and have armrests that give people leverage when standing up and support when sitting down. We observed lunch, being Friday, it was battered fish, chips and peas, everyone we asked said they enjoyed the meal and that it was well cooked. The meal looked appetising, in ample portions and was well presented. Condiments were on the table and the whole mealtime was calm and relaxed. There were no menus on the tables and no alternative meals had been prepared, so unless someone asked for something different on the day they would not be offered an alternative. We asked someone if they knew that they could ask for something different to eat and they said, no, when I asked if they would ask for something different, they said, No, I wouldnt want to rock the boat. Earlier in the day we spoke to someone who said that they were happy with the way they were looked after, the only thing they felt could be improved was the food. They said it was well cooked but there was not much variety, there are lots of stews, I love fish and would like to have more. The menu planner was in the kitchen; it was very dog-eared and was dated as Winter 2006, which indicates that the menus are not reviewed very often. They were a little repetitive; battered fish and chips every Friday and a roast every Sunday and there were several variations of stews and casseroles. The menus must be reviewed in collaboration with the people who will be eating the meal and alternatives to the main menu must be actively offered on a daily basis. Consideration should be given to displaying the menu somewhere in the dinning room or possibly to producing menus to put on the individual tables. We arrived at 8.30 in the morning and breakfast was already more or less finished, there were only a couple of trays left out for people who werent up yet. We feel that the breakfasts must have been served very early for everyone to have finished by that time in the morning. The provider told us that people tended to get up early, but we wonder if that is because they are woken by staff rather than being left to wake Care Homes for Older People Page 17 of 38 Evidence: naturally. There was a list in the kitchen, which stated exactly what everyone had for breakfast, and we were told that the night staff prepared it in advance. Peoples name and choice of breakfast is added when they move into the home, they are able to chose their breakfast from a list that consists of cereal, toast, bread and jam, fruit, fruit juice and a hot drink. Although ample in choice, it is a shame that people are not given an opportunity to make a fresh decision about what to have for breakfast when they get up. The kitchen was clean and well ordered. The cook showed us the cleaning schedule and safety checks. The home has been awarded a four star certificate from the Northamptonshire Council. Arrangements are in place to supply good quality meals to one person who has special eating requirements. Care Homes for Older People Page 18 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints policy which is displayed but there is no complaints recording system in place. Care staff receive safeguarding training but the provider still hasnt undertaken SOVA training required in a previous report. Evidence: The homes complaints procedure was displayed in the front entrance. It provided information on how to raise any concerns or complaints about the service, our contact details were displayed alongside the complaints policy. We were told that the home has not received any complaints since the last inspection, nor have we had any sent directly to us. I asked the provider if anyone had ever raised minor concerns or complaints, maybe about clothes going missing, a lost newspaper or a meal not being up to the usual standard. He said there had not been. We discussed the likelihood of there never being anyone who is unhappy or disgruntled in a home with 23 people living together. When a home records all of peoples concerns and complaints, no matter how minor they appear, it gives us confidence that the home listens and takes them seriously, it also assures us that if a serious complaint was made it would be dealt with appropriately. This is considered good practise and we recommend that the provider to put it in place. Care Homes for Older People Page 19 of 38 Evidence: There is no formal system for recording concerns or complaints that had been brought to the homes attention. It is important that there provider has a format in place ready to record complaints no matter how few are actually received. Safeguarding adults training had been provided for staff working at the home. The home still does not have a registered manager despite the provider assuring us that he was going to apply to be registered for that position due to the difficulties he has had in recruiting a manger. It was required in the previous report that the provider should attend safeguarding training for managers in this area. This is to ensure that the Northamptonshire multi agency safeguarding procedure is followed and that the provider understands his responsibilities for the people in his care. He has not undertaken this training yet and we reiterate how important it is, in the absence of having a registered manager in post, that he attend this training. We have been assured that he has booked a place on a course in the near future and we require that he informs us when he has completed it. Care Homes for Older People Page 20 of 38 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clare House is a safe, comfortable, well maintained environment. Toilets and bathrooms are sufficient to needs and there is specialist equipment to maximise independence. Bedrooms are individual to the occupant and suit their assessed needs. The home is clean, pleasant and hygienic. Evidence: During a tour of the building the bedrooms we viewed were clean, pleasantly decorated and furnished to a good standard. The rooms contained items of personal furniture, TVs, ornaments, photographs and pictures etc. Furnishings throughout the home were pleasant and of a good standard and suitable to the needs of the people living at the home. Recent building and refurbishment work has greatly enhanced the internal and external communal space available and a second conservatory has provided an area for them to receive visitors and also provides an additional communal facility. Since the last inspection there is evidence to demonstrate that the provider has continued to maintain the home to a high standard. The bathrooms and toilets are sufficient in number and were clean and decorated to a Care Homes for Older People Page 21 of 38 Evidence: good standard. Personal protective equipment was available for staff use. The second conservatory operates as the main entrance of the home, and a ramp was available to assist residents and visitors with limited mobility and those who require the use of a wheelchair to access the building safely. A large patio area with tables and chairs provides a pleasant outdoors area for residents and visitors to access safely. Care Homes for Older People Page 22 of 38 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are on duty each shift to meet peoples needs and the majority of staff qualified as required. Recruitment is managed badly and not all of the safeguarding checks are carried out. Staff have access to sufficient training. Evidence: The number of staff on duty when we arrived were adequate to meet the needs of the people living in the home and their names corresponded to those on the rota, but it did not indicate who the designated person in charge was. Its necessary for people to know who has responsibility for the running of each shift so that they know who to look to for guidance in an emergency situation. The carers we spoke with talked about people in a respectful manner and were knowledgeable about their needs. It was obvious, from the interaction between the staff and the people being cared for, that there was a good rapport and there was an easy atmosphere in the home. Staff told us that they undertake training and that many have an NVQ in care and we saw certificates to evidence this in the staff files. When we started to inspect the staff files we found that they were disordered and Care Homes for Older People Page 23 of 38 Evidence: mixed in their contents. To get a fuller picture of the recruitment process we looked at all of them. Some had most of the required information but most had very little. While looking at them we were unable to establish how many people had enhanced CRB checks, or how they were recruited or if satisfactory references had been received for everyone. Nor were we able to evidence that staff receive an induction that complies with the skill for life specification. When asked about the lack of information the provider acknowledged that the files were poorly kept and that two people did not had CRB checks done and that some of them have been done a long time ago. We discussed what would be needed to bring the files up to requirement and the provider had assured us that he will begin the process of reviewing them immediately and will make sure that all the checks are in place. Due to the overall poor rating of the home we will be carrying out another inspection within six months of this visit and we will examine the staff files again to establish that the work has been completed. Care Homes for Older People Page 24 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider considers the needs of the people in the home to have precedence over the administration and the management of record keeping, however to ensure they are fully safeguarded the record keeping, polices, procedures and safeguarding checks must be more robust. Evidence: The home has been without a registered manager for a long time. The provider has not been able to recruit the right person so he has decided to manage the house himself. As yet he has not applied for registration, despite assuring us during the last inspection that he would. He has again assured us that he would do so directly; we will follow this up at the next inspection. As a manager and the provider he must ensure that he meets all the standards applying to the registered manager as well as that of a provider. Care Homes for Older People Page 25 of 38 Evidence: In a previous inspection report it was required that he should undertake training in areas necessary for a manager, he has told us that he has started his registered managers award but not the managers safeguarding adults training. This is still outstanding and it will have to be met. We will be asking him to undertake other training appropriate to his role as a manager such as effective supervision skills and managing quality control. He will also need to undertake an NVQ4 in care. The provider acknowledged that staff do not receive formal 1 to 1 supervision. It is important that staff feel supported and that they are given an opportunity to receive guidance, to discuss ideas, to raise concerns and discuss career development. It is expected that all staff will have supervision at least six times a year. The home does not have a formal quality assurance process, where the people living there, their relatives and the staff are asked how they feel the home supports them and meets their needs. We sent surveys to the home in advance of the inspection and asked the provider to give them out. We did not get any replies, which is unusual and means that we only got feedback about the home from the people we met on the day of the inspection. The home does not manage peoples money. Occasionally relatives will give money to staff to pay a hairdressers bill or something similar. Previously the home has been required to supply a safe place for the money to be kept until the provider could take charge of it. A lockable box, fixed to a shelf has been provided but during the inspection we found an envelope that contained a cheque that had been left on a shelf just inside the medication room. It had not been put in the box for safety and there is no system in place to record when the money was handed in, by whom or when the provider had removed it. Staff must be reminded to use the locked box and to keep records. Staff spoken to in private confirmed that the registered provider puts the residents first and always has their best interests at heart, comments from residents confirmed that the registered provider is a good man, observations made during the visit of the providers interactions with residents and visitors to the home indicated that there was a good rapport, one person enjoyed a laugh and a joke with him and it was clear that relationships were good. Through observations of care practise and discussions with staff and residents it was clear that the staff and the provider know the residents individual needs very well, and that the health and personal care needs are being met. However there is a need for a more robust attitude to be taken towards record keeping, management and administration. Care Homes for Older People Page 26 of 38 Evidence: The manager feels that his priority is the care and support of the people living in the home and the staff, however failure to follow proper procedures could put people at risk of being abused and he must turn his attention towards managing the home in a professional manner. We suggest that the provider consider choosing one of his more experienced senior staff members and providing them with guidance and training to enable them to support him with the record keeping, supervisions and administration. There were nine requirements made at the last inspection only one of which have been met. This shows a disregard of the regulation process and an unwillingness to comply with the national minimum standards. Some of the requirements involve serious shortcomings and failure to comply with them by the next inspection will lead to the provider being referred to our enforcement team with the possibility of enforcement action being taken. All previously stated requirements and those made in this report must be actioned. Despite the home offering a good standard of care in an excellent environment, because this and the complaints section have been judged as poor the homes overall rating will be poor and this will mean that we will carry out another inspection within six months. This will give the proprietor an opportunity to get matters in hand and prove his management capabilities. Care Homes for Older People Page 27 of 38 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 1 4 (2)5 (2) A copy of the homes 30/11/2007 statement of purpose and service users guide must be available for service users or their representatives upon request. Records must be kept of all 30/11/2007 complaints made and include the details of investigation and any action taken. Where the registered 31/03/2008 provider is in day-to-day control of the home, he must meet all of the standards applying to the registered manager. (This requirement remains in force from the last two inspections) 2 16 22 3 31 10 (3) 4 32 17 (2) All money and valuables held 30/11/2007 Schedule 4(9) on behalf of service users (a) (b) must have a record stating the date the money or valuables were received or returned, and include a written acknowledgement of the return of the money or valuables. (This requirement is repeated from the last inspection) Care Homes for Older People Page 28 of 38 5 36 18 (2) All staff must be 31/12/2007 appropriately supervised and care staff receive formal supervision at least six times a year. Care Homes for Older People Page 29 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 6 The statement of purpose 09/03/2009 must be rewritten and care must be taken to include all of the required information and that it is written in a range of formats to make it more accessible to more people. By writing the document in a larger font or in Braille and by advertising a willingness to get it translated into other languages will indicate that the home is prepared be inclusive and flexible. 2 1 5 There must be a users guide 09/03/2009 in place and care must be taken to include all of the required information and that it is written in a range of formats to make it more accessible to more people. Care Homes for Older People Page 30 of 38 It is good to have a guide to the home that people can keep and refer to at a later date if they need to. 3 3 14 Every person moving into 09/03/2009 the home must have a complete and detailed assessment carried out that must be done is a way that will reflect their preferences, hopes and aspirations as well as their care needs. Assessing people in a way that is person centred will ensure that they receive care in a way that will meet their needs and enable them to receive support in a way that will promote independence and choice. Care management plans 09/03/2009 must be developed to clearly guide staff when they are caring for people that have special needs or challenging behaviour. Clear and detailed records must be kept. Difficult situations can be better dealt with if thought has already been put into why they happen, how they can be avoided and what is the best way to deal with them. Recording the events help people to analyse the cause and find ways to avoid them. 5 7 12 Daily notes must be written at the end of each shift 09/03/2009 4 7 12 Care Homes for Older People Page 31 of 38 giving a detailed account of the health and welfare of each person and what activities they have undertaken. As the habit develops for staff to record peoples daily activities and events, they will find the information collected useful in carrying out care plan reviews and in mapping changes to peoples health and abilities, any deterioration will be detected earlier. Health practitioners often find daily notes useful when tracking changes and in making a diagnosis. 6 7 15 Care plans must be in place for everyone in the home and will be done either prior to them moving in or as soon as possible if the placement was done quickly as an emergency. It is important that staff have access to as much information as possible when people first move into the home so that they will be able to offer what support is needed in the way people want to be helped from the moment they move in. New information can be added as to the care plan as it is gathered and during the monthly review of it. All care plans 09/03/2009 Care Homes for Older People Page 32 of 38 should be a work in progress; peoples needs constantly change as they get used to their new home and as they find what level of support they want. 7 10 18 Personal information must 09/03/2009 be stored in a way that will make sure it will be kept confidential. People will have little confidence that their privacy and dignity will be protected if they see that their private files are left out for everyone to see. 8 10 12 When referring to people in writing or verbally it should be done in a way that will not cause offence. Using derogatory language about people is upsetting and does not give the right message to carers. Instead of saying we value the people in our care and will treat them with respect it implies that it is alright for staff to be rude and judgemental. 9 15 16 The menus must be 09/03/2009 reviewed at regular intervals and must include an alternative to the main meal. In a care home meal times are important and are often the highlight of the day, 09/03/2009 Care Homes for Older People Page 33 of 38 they should be a stimulating and satisfying experience. Mealtimes are also an opportune time to support people to make choices and to voice preferences and they should be given every opportunity to make those choices on an every day basis. 10 16 22 The home must have a 09/03/2009 system in place for complaints and concerns to be recorded and staff must be made aware of where it is stored and how to follow the procedure. It is essential that all concerns and complaints are recorded in a way that makes it easy to follow their progress from start to finish. All issues raised must be recorded no matter how minor staff feel they are. 11 18 13 The provider must attend 09/03/2009 training on the Northamptonshire multi agency safeguarding referral procedures. In the absence of a registered manager there must be someone responsible that knows how the safeguarding system works and how and when to make a referral. 12 18 13 The provider must tell us the 09/03/2009 date of the proposed safeguarding training and Care Homes for Older People Page 34 of 38 contact us again when he has attended the it and other training we have required him to attend. By asking the provider to tell us when he starts and has finished the training we will be able to monitor his progress. 13 29 19 All staff must be in receipt of 09/03/2009 an enhanced CRB clearance and positive references before they start work at the home. There are some circumstances when staff can start work once they have received their poVAFirst clearance and before they are in possession of their CRB, but this should be only done as an exception not as a rule. Guidance on this subject can be found on our website. Letting people work without having all the safeguarding checks in place puts people at risk of being abused. 14 29 19 Staff files must hold all the information as set out in schedule 2 of the national minimum standards. We also need to see proof that the provider has followed the proper recruitment process as asked for in standard 29 and that the worker is suitable for the post as described in regulations 18 and 19. 09/03/2009 Care Homes for Older People Page 35 of 38 Only people who are of good character, have the right aptitude and is of integrity should work with older people, as they are often vulnerable and need to be protected from abuse. 15 31 8 The provider must be judged 09/03/2009 a fit person to manage a care home by taking part in our registration process. The home needs someone to manage it who has a good understanding of the national minimum standards and has shown a willingness to comply with them so that people can be confident that they will be properly cared for in a safe environment. 16 31 15 The provider must seek out and undertake training that is appropriate to the role of manager. This must include NVQ4 in care, effective supervision skills and managing quality control assessments. This will be over and above the a previous requirement that the provider undertakes safeguarding training. The role of a manager is different to that of a provider and the knowledge base needed to be an effective manager of a care home should be grounded on a good understanding of the national minimum 09/03/2009 Care Homes for Older People Page 36 of 38 standards and the Care Standards Act 2000. Not taking our guidance and advice seriously will eventually lead to a home failing to prosper and failing the people that live 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 1 15 Consideration should be given to displaying the menu somewhere in the dinning room or possibly to producing menus to put on the individual tables. Care Homes for Older People Page 37 of 38 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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