Inspection on 12/01/10 for Claremont Nursing Home

This inspection was carried out on 12th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Claremont Nursing Home 06/05/09

Claremont Nursing Home 10/05/08

Claremont Nursing Home 22/01/08

Claremont Nursing Home 24/01/07

Claremont Nursing Home 28/02/06

Claremont Nursing Home 14/09/05

Claremont Nursing Home 16/12/04

Claremont Nursing Home 23/06/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Claremont Nursing Home New Street Farsley Leeds Yorkshire LS28 8ED     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Carol Haj-Najafi     Date: 1 5 0 1 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 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Claremont Nursing Home New Street Farsley Leeds Yorkshire LS28 8ED 01132360200 01132360472 clmont@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Park Homes (UK) Ltd care home 63 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 63 The registered person may provide the following category of service only: Care Home with Nursing (N) To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Old Age, not falling within any other category, Code OP - maximum number of places is 63 Dementia, Code DE - maximum number of places is 10 Date of last inspection Brief description of the care home Claremont is a converted, extended, detached property, situated near the centre of the village of Farsley. The home is close to local bus routes and within easy access of a mainline railway station and the main roads to Leeds and Bradford. The home was first registered in September 1991. Park Homes UK Limited owns it. The home is registered to accommodate sixty three older people who can have nursing needs. Accommodation is offered in a combination of forty seven single and eight double rooms; all bedrooms Care Homes for Older People Page 4 of 35 Over 65 0 63 10 0 Brief description of the care home but one has en-suite facilities. Twenty six single rooms have a walk in shower. The communal facilities are four bathrooms and ten toilets. People have a choice of three lounges, and there are two spacious dining rooms. Gardens are available consisting of lawns and an enclosed garden to the rear, with level access from one of the lounges. Car parking is provided to the front of the property. At the inspection in January 2010, the manager told us the fees range from £551.77£781.50. Information about Claremont Nursing Home, including the last inspection report and up to date fees is available at the home. The homes Statement of Purpose and Service User Guide is available on request. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Care Quality Commission (CQC) inspects care homes to make sure they are operating for the benefit and well being of the people who use their service. More information about the inspection process can be found on our website www.cqc.org.uk. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The last key inspection was carried out in May 2009. We carried out this visit because concerns about the service had been raised and we decided it was appropriate to do an early inspection. Before this visit we reviewed the information we had about the home to help us decide what we should do during our inspection. Care Homes for Older People Page 6 of 35 Surveys were sent out to people who use the service, their relatives, healthcare professionals and staff. Eight surveys were returned, five from relatives, two from staff and one healthcare professional. Information from the surveys has been included in the report. Two inspectors were at the home over two days. The first visit was from 10:00 to 17:20 and the second visit was three days later and from 9:00 to 13:30. We spoke to six people who live at the home, seven visitors and eight staff, the manager, responsible individual and the director of the company. Some people have limited communication and cannot tell us if they are happy with the care they receive or if their needs are being met so we also observed interaction between staff and people who live at the home. We looked around the home and looked at care plans, risk assessments, daily records and staff records. Feedback was given to the manager, responsible individual and director at the end of our visit. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Care plans and assessments contain some good information but some peoples needs have not been fully identified. The care plans could provide more detail about how peoples needs should be met. People could have better support with their personal care. One person who lives at the home said, Things are generally good but sometimes they dont have time to give me a shave. Another persons daily notes only had one entry that they had been supported with a bath in six weeks. One relative said they were told the person they visited had a shower but they had noticed that the shower in the en-suite did not have a shower head. Sufficient quantities of medicines could be available to meet peoples needs at all Care Homes for Older People Page 8 of 35 times. All medicines could be kept securely and at temperatures recommended by the manufacturer. All medicines could be given correctly as directed by the prescriber. Medication records could be made and maintained in an accurate and timely manner. People who live at the home could be offered more activity on a daily basis. The home has introduced outings and entertainment evenings and occasionally entertainers visit the home but people could have more stimulation. Menus in the home could match the meals that are provided. On the first day of our site visit, people had chicken and dumplings or lamb casserole and rice pudding. The menu said they should have been eating liver casserole or roast chicken and semolina. There is no record of meals when they differ from the menu. Safeguarding processes could be more robust. Some of the concerns that were raised about the home have related to safeguarding and the home having failed to protect people and report safeguarding incidents to the relevant agencies. The management team has worked hard to improve their systems and this has been recognised by professionals who have worked alongside the management team to monitor the service. A recent safeguarding incident was reported and dealt with appropriately. However we found recent incidents where people who live at the home have made allegations that have not been reported to the relevant agencies. The home could have a better cleaning schedule to make sure all areas of the home are clean. Staffing could be reviewed to make sure there are enough staff to meet peoples needs in a timely way. We observed that some people were not receiving support at the right time because staff were not available. Administration of medication was delayed and some people waited forty minutes for their lunch. The manager could submit a registered managers application. This will make sure the home has a registered person that is in day to day control of the service. The management approach of the home could continue to be developed to make sure everyone who works at the home has clear direction and understands the aims and purposes of the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 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. Peoples needs will be properly assessed before they move into the home, which makes sure their needs are known. Evidence: At the inspection in May 2009 we found that people experience good outcomes in this area and the home makes sure peoples needs are properly assessed before they move into the home. Since the last inspection the home has admitted only a few people and no one has moved in since October 2009. Admissions to the home were suspended by the local authority because the home was not providing a safe service to the people who were living there. The home is going to start readmitting people because they have made improvements to their service. Care Homes for Older People Page 11 of 35 Evidence: When we visited the home thirty six people were living at the home although the service is registered to provide a service to sixty three people. We talked to one person who moved into the home six months ago and their relative. They told us they had settled in reasonably well and were satisfied with the admission process. In the AQAA the responsible individual said, Once the home is open again to admissions, prospective residents will be allocated a lead nurse and named key worker upon deciding which room they would like to occupy and they will conduct the preassessment so that the resident from the onset has a familiar face to relate with before admission and once living in their new home. We talked to the new manager who will be responsible for co-ordinating admissions to the home. She said they would only admit people after their needs have been assessed by the home or a social or healthcare professional. We looked at two peoples assessment records that have moved in since the last inspection. They had detailed assessments that were completed before the person moved into the home. The assessments contained good information about the type of support they required. Care Homes for Older People Page 12 of 35 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. In the main, people who live at the home are treated with dignity and respect although they do not always receive care at the time they want or need it. Care plans identify some care needs well but other care needs have not been identified so we cannot be sure that peoples needs are being properly met. Some medication practices put people at potential risk. Evidence: We talked to people who live at the home and their relatives and received mixed feedback. Some people said they are happy with the care; others thought the home could improve some aspects of the care. Generally, people said the care staff are good. One person who lives at the home said, The staff are champion. We have a laugh and I pretend to be their granny. Another person who lives at the home said, Things are generally good but sometimes they dont have time to give me a shave. One relative said, The care staff are wonderful. Some people raised concerns about staffing levels and thought staff do not have Care Homes for Older People Page 13 of 35 Evidence: enough time to spend with people who live at the home. We observed that some people were not receiving support at the right time because staff were not available. Administration of medication was delayed because the nurse was busy. Some people were given their lunch when they first arrived in the dining room; others waited forty minutes. Staff who were asked about the delay at lunch said this happens when they are busy although one staff said it was delayed more because of the inspection. We have covered staffing issues in more detail under the staffing section of the report. As mentioned in the last section, admissions to the home were suspended because the home was not providing a safe service to the people who were living there but the home has since made some improvements. In the main, relatives agreed with this. They thought the home had made some good improvements and said the home is cleaner and meals are better although they thought there was still further improvements needed. One relative said, They still have a long way to go. Another relative said, It improved a great deal but Im worried its slipping back. We talked to six care staff and two nurses. Generally they thought people who live at the home receive good care. Some staff said the staffing levels were satisfactory; others said they are busy and if people are poorly they do not have enough time to do everything on time. In the AQAA the responsible individual said, All our team deliver the best care and service to our residents with the resources available to them. Our team is skilled and experienced in many areas of healthcare and social care delivery. We have introduced the Gold Standards Framework advanced care register for residents that have entered the last 12 months (or less) of their life. Staff talked about promoting privacy and dignity and gave us examples of how they do this. Part of the day was spent talking to people and observing the care being given to people. This included how staff interact with people at the home. Staff treated people with respect and they were kind and courteous. We saw some very good practice, which included a care staff giving out afternoon tea. She talked to everyone individually, giving them time and listening to what they were saying. She spoke to people with warmth and it was evident from peoples responses that she was a popular member of staff. We also saw evidence that some staff were rushing. At lunch time people were asked what they want to eat but staff did not always listen carefully to what people were saying. The general appearance of some people who live at the home was good, they were dressed appropriately and attention had been given to their personal care. For Care Homes for Older People Page 14 of 35 Evidence: example, peoples hair had been brushed and their glasses, shoes and clothing were clean. Other people did not look as though they had been given proper support with their personal care. One person was unshaven and said staff had told them they didnt have time to shave them. Overall people were satisfied with their care and felt staff knew how to look after them. One relative said people dont get enough opportunities to have a bath. We looked through peoples daily records. Often the notes were repetitive and didnt say what care people had received. For example most peoples notes state personal cares given but do not explain what personal care has been given. One persons daily notes only had one entry that they had been supported with a bath in six weeks. One relative said they were told the person they visited had a shower but they had noticed that the shower in the en-suite did not have a shower head. Staff do record some important information about peoples health and welfare. The records have good information about healthcare appointments and show people are receiving regular input from healthcare professionals. We looked at four peoples care files. These were well organised. Some information in the care plans was good and gave sufficient information about potential risks and how individual needs should be met. One care plan stated that the person likes to spend most of their time in their room but occasionally they should be encouraged to spend time in communal areas. Staff and the daily records told us that the care plan is followed. While there was evidence of some good care plans and progress towards individualised care planning, there is room for improvement in others which were vague. For example, one care plan said, maintain privacy and dignity and another care plan said, ensure oral care. This guidance is about care practice and should always be followed for everyone living at the home. Some information was missing from care plans. Some staff told us one person shouts out and grabs staff. The persons care plan contained no information about this. Daily records told us that one person needs additional care for hygiene to reduce the risk of infection but there was no reference to this in their assessments or care plan. One person we spoke to had been involved in caring for their relative at home. The care records did not indicate any involvement of this person in developing the plans of care. This could result in individual preferences being overlooked. Care Homes for Older People Page 15 of 35 Evidence: A range of risk assessments have been completed, and these identify the level of risk. Each assessment has been regularly reviewed. The care plans and assessments are completed by qualified staff. Care staff said they can write the daily notes but do not really get involved. The new manager and responsible individual said they are continuing to develop person centred care and care planning which will help improve the care planning process. The pharmacist inspector examined the medication ordering, storage, handling and record keeping arrangements in the home and found the following concerns. One person had not received an essential prescribed medicine for the previous four days as none was available in the home to give. Another person was still using eye drops from a bottle which should have been discarded on 4th January as this was the only bottle available in the home to use. The home must make sure that there are always sufficient medicines available to give as and when needed. Some peoples medicines prescribed to be taken at breakfast time had still not been given at 1pm. A nurse on duty explained that a GP visit had caused an hours delay in completing the usual medicines administration task that morning. Two peoples medication administration record charts (MARs) were not signed or completed at the time the medicines were offered or given. The nurses on duty again explained that they had been distracted by visitors and had forgotten to sign the MAR. It is important that sufficient trained and competent staff are always available to meet everyones needs in a timely manner. One person whos dose of medicine is determined from the results of a regular blood test had not had such a blood test since March 2009. This means that staff can not be sure that the prescribed dose given each day is still appropriate or safe. The MARs of four people showed a total of twelve new hand written entries which had not been checked. Eight such entries had not been signed by the nurse making the entry and two lacked any directions for the use of the medicine. All hand written entries and changes to printed MAR entries should be checked for accuracy or completeness by a second person and should contain sufficient detail to enable the medicine to be given correctly. Two people had each recently completed a short course of antibiotics and the MARs indicated that more doses of antibiotics had been given than had been supplied by the pharmacy. Eight containers of medication were selected randomly to check whether the quantity remaining was the same as that predicted from the records made on the MAR. Six items were correct but for two items, a larger quantity remained than expected. It is Care Homes for Older People Page 16 of 35 Evidence: therefore difficult to know whether all medicines are given corrrectly as directed, despite the very few gaps on the MARs. Although medicines are stored securely, the temperature of the medication store room remained at around 30C throughout the duration of the visit which is higher than the manufacturers recommended storage temperature of below 25C. If this high temperature persists, staff may not know whether these medicines continue to be safe to use. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Choice is promoted but because care plans do not contain enough information about preferences peoples routines are not always person centered. People enjoy organised events but would benefit from more stimulation on a day to day basis. This would help make sure people have a more varied lifestyle. Evidence: People who live at the home told us they can choose where to spend their time. One person said, Staff bring me to this lounge because they know I like it. Its more cosy. A relative told us staff make sure the person they visit spends time in their preferred lounge. Another person who lives at the home said they like to spend time in their room and staff always check they are ok. We spoke to six relatives. They told us they visit regularly and can spend time in communal areas or in peoples rooms if they prefer. They said they can visit at anytime. In the AQAA the registered manager said, We have an excellent social needs assessment form and life history booklet which is used to collate information about the Care Homes for Older People Page 18 of 35 Evidence: residents life and interests. We looked at two peoples files. Both had a social needs assessment. One file had a life history booklet, which had been completed by a relative and had some very good information about the persons past. People generally thought the level of activities should improve and said there should be more to do on a daily basis. The home has introduced outings and entertainment evenings. Occasionally entertainers visit the home and a motivation session is offered to people. A hairdresser visits twice a week. The homes activity organiser has been absent for two weeks and the home has had a bout of illness affecting a number of people which, the management team said, impacted on the level of activity. We looked at activity records but these did not show that people are involved in regular activities. The management team said the activity programme has improved in the last few months but acknowledged they have not recorded what activities have been offered and agreed it could be further improved. Staff said the routines are generally flexible and they try to make sure people get up when they want although as stated in the previous section this practice is not always followed. Bedrooms are on three floors. Staff said they will start getting people up on one floor and then move to another floor but to make it fair they start on a different floor each day. Care plans did not contain information about peoples preferred times for getting up. People told us they always have enough to eat and the food is good, and said it has recently improved. We observed regular drinks and snacks being offered to people. Lunch was very disorganised and as stated in the previous inspection, some people had to wait a long time for their meal. At lunch time, in one dining room four people needed support to eat their meal but for forty minutes only one staff was available. On the other unit the lunchtime meal was managed by the care staff. We felt that staff were under pressure with one organising the mealtime, one taking meals to people in their rooms, leaving one staff to supervise people in the dining room. Out of five people in this dining room, three clearly needed varying levels of support and encouragement. The member of staff was only able to give full support to one person at a time. This meant that meals could be cold before others could receive the help they needed. One of the three staff in this area was a supernumerary apprentice carer but the mealtime could not have been managed without her input. At feedback we discussed whether kitchen staff could be more involved at the mealtmes to make sure that care staff are able to concentrate on their caring duties Care Homes for Older People Page 19 of 35 Evidence: rather than having to go back and forth to the kitchen for food, crockery and cutlery. People were asked at the time of serving what they would like to eat, which is good practice because people can choose what they want at the time they are eating. The meal was nicely presented and look appetising. Everyone appeared to enjoy the food. The menus that were being followed do not match what meals are being provided. On the first day of our site visit, people had chicken and dumplings or lamb casserole and rice pudding. The menu said they should have been eating liver casserole or roast chicken and semolina. There is no record of meals that are provided even when they differ from the menu. We asked catering staff for information about special diets on the first day of our site visit but this information was not available. This information was available on the the second day of our visit. The chef, who has recently started working at the home, said that they are changing the menus because they want to make them more varied and nutritious. The new menus should be in place by the end of January. Care Homes for Older People Page 20 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has introduced better systems to improve their complaints and safeguarding practices but they still have to make further improvements to make sure their processes are robust. Evidence: In the AQAA the responsible individual said, We operate an open door policy where residents, relatives, staff and visiting professionals can discuss any aspect of our service openly and our approach to constructive criticism is transparent. The complaints procedure was displayed in the entrance of the home. People who live at the home told us they talk to their relatives or staff if they are unhappy. Relatives said they know how to make a complaint about the care provided by the care service although some people said the care service has not always responded appropriately if they have raised concerns. Staff said they would report any concerns to the management team and they were confident they would deal with them promptly and appropriately. The information provided to us did not appear to be complete. We were told that complaints records are kept electronically and systems are able to demonstrate the progress of a complaint through the stages of the complaints procedure. In the AQAA the responsible individual told us, The home has a whistleblowing policy Care Homes for Older People Page 21 of 35 Evidence: that all staff are made aware of during their induction and during their safeguarding of vulnerable adults training. The Company adult protection procedure clearly highlights to staff where to report any adult abuse concerns and describes the various acts of abuse that residents can be subjected too and the signs and symptoms staff are to look out for if they suspect a resident has been subjected to any act of abuse. Staff we spoke to said they have received adult abuse awareness training, and said they would report any concerns to the management team if they suspected abuse or had an allegation of abuse made to them. They did not know that the home should report any safeguarding incidents or allegations to the local authority. The manager said she has spoken to the local authority and will be attending their safeguarding training. We asked to look at the homes safeguarding policy. The management team could access this on the computer but staff did not know how to access the policy. Some of the concerns raised about the home since the last inspection were that the home failed to protect people and report safeguarding incidents to the relevant agencies. The management team have worked hard to improve their systems and this has been recognised by professionals who have worked alongside the management team to monitor the service. A recent safeguarding incident was reported and dealt with appropriately. However, at this visit we looked through four peoples daily records. Two peoples records contained recent incidents where people who live at the home have made allegations. The manager has investigated the allegations but has not reported the allegations to the relevant agencies. Care Homes for Older People Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable environment. Most areas of the home are clean but dirt has built in some parts that are not included in the regular cleaning regime. Evidence: People who live at the home and visitors told us the home is comfortable, tidy and doesnt tend to have any unpleasant odours. They said some areas are clean but others areas need more cleaning. Visitors generally thought the environment had improved in the last few months. One person said it could be more homely if they added some additional touches such as ornaments. When we looked around the home it was tidy but not all areas were clean. One area in the dining room was very dirty. The wall, floor and window, near where the food trolley stands, had stale food and drink spills that had built up over a period of time. We pointed this out on the first day of our site visit but it had not been cleaned when we went back three days later. Some areas such as paintwork on staircases were dusty and it was evident that they had not been cleaned for some time. Other areas of the home such as lounges and bedrooms were clean. The home was reasonably well decorated and furnished although in some rooms paintwork was flaking and badly marked so should be redecorated. Care Homes for Older People Page 23 of 35 Evidence: The home is divided into two units but people can choose to spend time on either unit. There is a dining room on each unit and ample communal areas. There are two passenger lifts and a staircase that allows access to all floors. Assisted bathrooms and toilets are situated near to peoples bedrooms and communal areas on all floors. All rooms seen were clean, free of odour and maintained to a reasonable standard. People have been able to furnish their rooms with pictures and photographs. Clinical waste is properly managed and staff wear protective clothing when attending to the personal care needs of people who live at the home. Hand cleaning facilities are situated throughout the home. However, on the first day of our visit we found that one of the soap dispensers was empty and had gunge around the bottom of the dispenser. When we returned a few days later it had not been cleaned and was still empty. In December 2009, a food hygiene inspection was carried out by the local authority. Some food records were not accurate and some equipment was found not to be clean or in good working order. The chef said they were working through the recommendations to make sure food hygiene is satisfactory. Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are happy with the quality of staff that support them. Although staff do not always have sufficient time to meet peoples needs at the appropriate time or spend quality time with them. Evidence: People who live at the home and visitors were complimentary about the staff that work at the home. People described staff as hardworking, nice and caring. Some concerns were raised about staffing levels. The management team explained that they have split the staff into two teams, which has improved allocation of duties and made workloads more manageable. As stated in the Health and Personal care section of this report we found that, at times, people were not receiving care at the time that suited them. Concerns were raised about staffing levels in some of the surveys we received. One survey stated, Staff presence is better than it was but there are still times when residents are unsupervised and no staff are in evidence. Another surveys stated, Despite the amount of staff, there never seems to be anyone when needed. Some staff said the staffing levels are satisfactory; others thought the staffing levels are not satisfactory and said they do not have adequate time when people are unwell Care Homes for Older People Page 25 of 35 Evidence: or need some additional time. The management team said they have completed a staffing level assessment that is based on individual needs but agreed they would look at how staff are used within the home as well as the staffing levels. In the AQAA the responsible individual told us, The home is staffed in accordance with residents dependency levels and additional staff are rostered to work if residents dependency levels increase. We found that this does not always happen. We received some positive feedback from staff about what the service does well. Staff told us the team generally works well together. One person said, Staff are very committed and help each other. Staff told us they receive good training and receive training that is relevant to their role. A training plan is in place and the information provided showed that mandatory training has been completed for most staff. Mental Capacity Act and Deprivation of Liberties training was completed for a lot of the staff by the local authority in September and November 2009. In the AQQA the responsible individual told us that out of the twenty four permanent care workers only three hold an NVQ level 2 certificate in health or social care. In the AQAA the responsible individual said, We have a robust recruitment and selection process that is in place to safeguard residents. At the last team leader interviews a relative participated and was on the interview panel and helped with the selection process. We looked at the recruitment process for three people who have recently started working at the home and found that all necessary pre employment checks had been completed. Care Homes for Older People Page 26 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team has taken good steps to improve the quality of the service although further steps are needed to make sure people are receiving a consistently high standard of care. Evidence: Several people told us the home has made some good improvements in the last few months and said the responsible individual, who worked at the home for a period of time, has led the changes. The new manager, who has only been in post for a few weeks said she is working with the organisation to continue making further improvements. Since the last inspection the home went through a period where it was not being properly managed and people were not receiving a good standard of care. The organisation has taken steps to address this. We received some very good feedback about the new manager. Staff described her as Care Homes for Older People Page 27 of 35 Evidence: professional, knowledgeable, a good leader and firm but fair. The manager said she is preparing her registered managers application and is hoping to submit this shortly. Some concerns were raised about the management of the home. One person said the management team has taken action to put things right but then let things revert back. Another person said they didnt think management handled a recent event sensitively. Some of the difficulties at the home appear to have arisen because everyone is not working as one team. People talked to us about some groups of staff working as a team but this did not apply to the whole team. We discussed this with the management team who said they were aware of these problems and are working with everyone to address the problems and improve team work. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA gave us information about the service but in some sections it did not give us much information. It gave us examples of what they do well and changes they have made as a result of listening to people who use the service. The AQAA contained some information about what they could do better or how they plan to improve but didnt cover most of the areas that we identified during our inspection even though the management team were aware and dealing with some of the issues. A range of quality assurance systems are in place, which include consulting different people who are involved in the service. Surveys are sent out, and meetings are held for people who live at the home and their relatives. Monthly visits are carried out by a representative of the organisation to monitor the quality of the home. Quality assurance audits highlighted areas where the home could improve, and the management team were using this information to help identify where they should make improvements. The manager said generally they do not hold monies on behalf of people who live at the home. Sometimes families leave a small amount of cash. Purchases are recorded and receipts are obtained. When we asked staff about supervision and support they all felt well supported and felt they had enough training and regular supervision. In the AQAA the responsible individual told us they have all relevant policies and procedures in place, and equipment has been tested as recommended by the manufacturer. Care Homes for Older People Page 28 of 35 Evidence: We looked at some accident and incident records. These had sufficient detail about incidents that had occurred and action points to help prevent a similar incident occurring again. We did not observe any unsafe working practices during our visit. Staff were confident when they used lifting equipment. We spoke to one person just after they had been hoisted from a wheelchair to an armchair. They said they felt safe when staff transferred them. Care Homes for Older People Page 29 of 35 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 30 of 35 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 15 People who use the service must have a care plan that identifies their individual needs and how they should be met. This will make sure peoples needs are met. 31/03/2010 2 9 12 Arrangements must be 12/02/2010 made to ensure that there is an effective system in place to request, obtain and retain adequate supplies of prescribed medicines. This is to make sure that people can be given their medicines as and when needed. 3 9 13 Arrangements must be made to ensure that all medicines are stored securely at the correct temperature recommended by the manufacturer. 12/02/2010 Care Homes for Older People Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to help make sure staff know they are safe to use when needed. 4 18 13 Any allegations of abuse must be reported to the relevant agencies which are identified in the homes safeguarding procedure. This will make sure people are protected. 5 26 13 All areas of the home must be clean. This will reduce the risk of infection and make sure people live in a clean and safe environment 6 27 18 The staffing arrangements must be reviewed to make sure that there are enough staff to meet the needs of the people living at the home, taking into account the size and layout and purpose of the home. This will make sure peoples needs are met. 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 12/02/2010 28/02/2010 28/02/2010 1 7 Daily records should provide sufficient information about Page 32 of 35 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 how peoples needs have been met. This will make sure their health and welfare can be properly monitored. 2 3 4 5 6 7 7 9 9 9 9 10 All staff who support people who live at the home with their care needs should be involved in the care planning process. Dates of first opening should be marked on all containers oral liquids and skin care products. Hand written MAR entries should be checked for completeness and accuracy. Regular checks of controlled drugs usage should be made and recorded in the controlled drugs register. The medication policy and procedures should be updated in line with current professional guidance. People should receive personal care that is appropriate to their individual needs and wishes. This will make sure their needs and wishes are met. People who live at the home should be offered more daily activities. This will give people a more stimulating and fulfilling lifestyle. Routines should be planned around peoples wishes and preferences. This will make sure people can exercise choice and control over their lives. Meals that are served to people who use the service should be recorded. This will make sure nutrition and variety of meals can be monitored. The homes safeguarding policy and procedure should be formally shared with staff and be available at the home. The home should have a decoration programme to follow. This will make sure people live in a pleasant environment. Hand washing dispensers should be restocked with appropriate liquid when they are empty. This will help reduce the risk of infection. The ratio of care staff that hold an NVQ level 2 qualification in health and social care should be at least 50 . The manager should submit a registered managers application. This will make sure the home has a registered person that is in day to day control of the service. 8 12 9 14 10 15 11 12 13 18 19 26 14 15 27 31 Care Homes for Older People Page 33 of 35 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 16 32 The management approach of the home should continue to be developed to make sure everyone who works at the home has clear direction and understands the aims and purposes of the home. Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 35 of 35 - 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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