Inspection on 01/06/09 for Clevedon Court Residential Home

This inspection was carried out on 1st June 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Clevedon Court Residential Home 24/09/08

Clevedon Court Residential Home 26/09/07

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Clevedon Court Residential Home 1-3 Clevedon Road Weston Super Mare North Somerset BS23 1DA Lead Inspector John Clarke Unannounced Inspection 1st June 2009 07:30 DS0000070055.V376060.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 2 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 Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clevedon Court Residential Home Address 1-3 Clevedon Road Weston Super Mare North Somerset BS23 1DA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01934 621981 01934 621981 ANJ & ASH Care Ltd Manager post vacant Care Home 22 Category(ies) of Learning disability (3), Old age, not falling registration, with number within any other category (22) of places Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) 2. Learning disability (Code LD) - maximum of 3 persons The maximum number of service users who can be accommodated is 22. 24th September 2008 Date of last inspection Brief Description of the Service: Clevedon Court provides personal care for up to 22 people elderly people. The home also cares for 3 elderly people with a learning disability. Clevedon Court is set just off the sea front, with level access to the town centre. All bedrooms have en-suite facilities, and two of the en-suites have bathing facilities. There are 21 bedrooms, one of which may be used as a double. At present, all are being used as singles. All bedrooms meet the new spatial standards and many exceed them. There is a passenger lift accessing both sides and both floors of the home, and a stair lift, which accesses three bedrooms on a mezzanine floor. The mezzanine level is also accessible via a ramp. The provider makes information available through a brochure and information pack. The information pack contains the Statement of Purpose and Service User guide and all relevant information about the home. The fee is £382.64 a week with additional charges being made for hairdressing, chiropody, newspapers, and toiletries. Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This inspection was bought forward because of concerns registered to us about the running of the home. We had previously undertaken a random inspection on 14th May 2009 again following concerns about staffing and other matters which were raised with us anonymously. At present the home is under the temporary management of Ms J. Kendrick who is the registered manager of Granada House which is under the same ownership as Cleevdon Court. We looked at a number of records relating to the quality of care provided in the home including pre-admission assessments, care plan and arrangements for the management and administration of medication. We also looked at staffing recruitment and training records and those relating to the health and safety practice in the home. What the service does well: There is clearly a committed and loyal staff group who despite the difficulties of changing managers and lack of manager have continued to make every effort to provide a quality service. Individuals we spoke with were very appreciative of the staff of “the work they do”. Comments included “staff very good” “they work hard for us”. Individuals told us that they can “do as we wish” “its our home” and they commented on the availability of staff. Staffing arrangements in the home have improved with recruitment of new staff and additional staff on duty. However the issue of night staff must be addressed. What has improved since the last inspection? At the last inspection we made a number of requirements about care plans, risk assessments and staff training. We looked at care plans on this inspection and found that the area we had identified as needing improvement namely involvement of individuals had improved. Risk assessments are in place though Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 6 this remains an area of improvement, as does the need for Infection Control Training. What they could do better: We have made a significant number of requirements from our last two inspections to the home and they reflect in our view the deterioration of the service since our last inspection in 2008. This has co-incided with the resignation of two managers and deputy manager which has we believe resulted in a decline in the quality of the service provided in the home and associated risks particularly around health care needs of individuals who live in the home. Alongside this are the shortfalls in recording relating to care planning information, recruitment and selection, medication management and training. Requirements have been made regarding the need to improve care planning practice too improve the quality of information about individual needs in relation to moving and handling assessments, maintaining skin integrity and nutritional needs. These all have potential impact on the health and welfare of individuals who live in the home. A real concern is the lack of involvement of community health professionals in supporting the home where individuals are at risk from skin breakdown and where the home has implemented the use of bed rails there is not robust procedures and practice in place to make sure that their use is within a risk assessment framework. Further the use of equipment, which may not be appropriate to the particular individual, and again its use (this is with reference to rails) are not monitored to identify the safety of continued use. The removal of bumpers when using bed rails may present risks to the individual. We have also identified that whilst individuals who live in the home have access to health services this is not monitored or action taken where individuals refuse such service i.e. chiropody. Whilst we do not question the right of individuals to refuse such services it is the duty of the manager to ensure that such refusal doesn’t present real health risks to the individual because of their action. Further to look at whether it is necessary to identify the need to take any steps to make sure that individual’s health is protected. Medication arrangements in the home again present risks specifically the use of pots this is not acceptable practice and the manager was advised at the time of our visit that this practice must cease. There were a number of shortfalls around the recording, administering and management of medication. Requirements have been made in relation to these areas of practice so that risks to individuals when administering or managing their medication are alleviated. The actions of the acting manager when addressing a Safeguarding incident whilst protected those in the home failed to address the potential risk to those living in other care homes where this member of staff may in future decide to work. The manager did not illustrate a real understanding and knowledge of the required practice and procedures in relation to responding to possible abuse. A referral and full independent investigation led by the local authority would have substanted whether the incident was abusive and if this was Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 7 proven the individual would have been referred for inclusion on the Protection of Vulnerable Adults list. In the event this inclusion was made the individual would not have been able to work in any other care setting. The recruitment practice of the home potentially places individuals at risk in that staff have been recruited without full information about their previous employment in the way of references it is noted that the two staff members this refers too were recruited by the acting manager and not previous managers reflecting directly on her practice. The shortfalls identified by this inspection in relation to the training of staff is also the subject of requirements. The acting manager recognised this area must be addressed however there are staff who have not completed what are considered “mandatory” areas of training i.e. moving and handling, food hygiene, infection control. There was also a gap in staff having training around specific areas of need in order that they have a broader knowledge base. It is of concern that the home manager or owner has not responded to the notice issued by the Avon Fire and Rescue service in 2008 about the lack of fire alarms which are directly linked to the homes fire alarm system. In our view this neglects their duty of care in making sure that the necessary system is in place to protect individuals in the event of a fire in the home. This would also apply to the issue of making sure that water temperatures are at the necessary temperature to prevent scalding. 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. Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the 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 home undertakes pre-admission assessments so that they can make an informed decision as to their ability to meet the identified health and social care needs of the individual. EVIDENCE: We looked at a pre-admission assessment and they provided information as to the medical history, medication, physical health and personal circumstances of the individual. Where individuals are known to the local authority a copy of their assessment is obtained by the home. Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Planning arrangements do not adequately reflect the needs of individuals living in the home so that the necessary information about the daily care needs is recorded ensuring that the health and care needs of the individuals are identified and met. The failure to manage use of use i.e. bed rails potentially places individuals at risk of injury. Arrangements for managing resident’s medication fail to make sure that resident’s health needs are protected and potentially place individuals at risk. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: We looked at care plans for 5 individuals who live in the home. They showed information as to Physical Health and Well-being, Medication Profile and Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 11 Mobility. Tasks were identified such as “Staff to obs (observe) all skin areas, wash and cream pressure areas day and night—feet and heels obs” and this had been recorded as completed in Daily Notes. Staff also told us this was part of their care routine. Risk Assessments had been completed for one individual where there was risk of their leaving the home. For another individual who has Epilepsy a risk assessment had been completed however there were no specific instructions as to how to respond when the individual had a seizure. For one individual there was specific instruction as to use of wheelchair and this was observed as being undertaken during our visit. There were no specific moving and handling assessments included in the care plans that we looked at as part of care planning information. This was the subject of a requirement at our previous inspection in 2008. There were no Pressure Area/Waterlow assessments in place or use of nutritional assessments. There was inconsistent practice around the recording of individual weight. Reviews of care plans had taken place. We established that there are two individuals living in the home who have bedrails however there was no assessment as to evidencing the need for such equipment to be used or evidence of assessment by health professional. Consent had been obtained for “cot sides” for one individual however this was not dated. “Cot Sides and Bumper Risk Assessment” had been completed for one individual (18/05/09) On our previous visit of 14th May 2009 one individual had bed rails with two bumpers (rail protectors) in place however on our subsequent visit one had been removed for use of another individual. The manager advised that additional bumpers were on order from supplier. There was no record on the monitoring and reviewing of the use of rails with regards to possible hazards or need for any adjustment/maintenance. We looked at records relating to visits by health professionals such as chiropodist, district nurse and GP. For one individual daily notes referred to “District Nurse or GP to advise on sore” (04/05/09) notes indicated staff were applying dressing. There was no record until 12/5 indicating advice had been sought but this individual had not been seen by GP or District Nurse regarding the “sore”. For another individual daily note stated “sore on bottom. …sudo cream and dressing applied” (11/05/09) District nurse visited 14th, 15th ,19th but no record of advice given. At time of our visit the sore had improved. We looked at records relating to visits by a chiropodist and found that for one individual care plan stated “needs to see chiropodist every six weeks” but the last recorded visit had been on the 26/11/08, for another individual last recorded visit was 11/03/09, another 13/04/09 and another 26/11/08. This was discussed with the acting manager at time of our visit she advised that the chiropodist had visited the home however some individuals including those identified had refused treatment. No further action had been taken to address this failure to have treatment on the part of the individuals concerned. Records showed that optician had visited the home in the last month. We spoke to one individual about visits by Gps they told us “this is not a problem” and that staff had responded well to their request to see a doctor. Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 12 On our arrival at the home we found medication loose in pots we asked member of staff if this was the normal practice. She told us that one individual had refused their medication and this was why it was in pots. However on asking the same staff member again whether this was normal practice i.e. to administer medication from pots rather then directly from blister packs she replied that it was. We also asked another member of staff about the practice of administering medication in the mornings “we take them out of the packs and put into pots then give to resident”. We looked at the administering records and found in period of one week 26/05/09 there were a number of gaps: one individual had no record of Warfarin being given on four occasions, another individual had no record of medication being given on three days. There were also a number of gaps for other individuals. One individual was being given a controlled drug this was not being kept in separate secure storage but in medication trolley. There was no controlled drug separate storage or controlled drug register the manager advised us that these were being ordered. When controlled drugs had been given to individuals there was not two signatures of staff and where changes had been made in writing on administering records these had not been signed and witnessed by staff members. Returns book was being kept however it was noted that there was controlled drug dated 20/03/09 and 21/05/09 which were no longer being prescribed to the individual and had not been returned to the pharmacist. There was separate fridge storage however no record of temperature checks being made. Two individuals were receiving eye drops there was no date when this medication had been opened in that this medication has limited life span once opened. We spoke to individuals who live in the home about the approach of staff specifically whether they felt they were treated with respect and spoken too as they would wish. Individuals told us “they are all very good” “they treat me very well” “yes very respectful” “can’t fault them”. We were able to observe staff during our visit and noted that staff were very supportive and sensitive in their approach particularly when they were assisting an individual with personal care. Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the 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 arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. However there needs to be clear meal choices given to improve the meal experience for individuals who live in the home. EVIDENCE: We spoke with individuals who live in the home about the activities available to them. They told us that “staff sit and have a chat with us” “we sometimes play Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 14 games”. One individual told us “could do with more sometimes”. Another individual told us a staff member sometimes takes them out to the shops. We asked about visitors to the home and one person told us “there’s no restriction on visitors”. We spoke to a relative who told us they “always find staff friendly and approachable”. We asked individuals about their ability to makes choices and how they spend their day. One person who by choice spends a lot of time in their room told us “its not a problem me spending time in my room its up to me, staff will always let me know if there’s something going on”. I asked another individual about getting up and going to bed they said, “It’s down to me, I choose”. A staff member told me “we always try whenever we can to do what the resident wants it’s their home”. On both of our visits to the home we were present during the main meal of the day. It was well presented and looked appetising. However there was one individual who needed their meals puréed and their meal was given with all the ingredients together i.e. not separate as is recommended. I discussed this with the cook at the time of our visit. It was unclear how much of a choice individuals are given this was not displayed on the menu board and whilst one individual told us there was always a choice others said, “there is no choice” “very rarely”. Individuals told us the food and meals were “good” “I enjoy the food here”. We looked at the menus and again there were no specific choices though the meals were varied. The cook told us that they were looking at including choices on the menu though they maintained a choice was always offered. Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 clear procedures in place and this enables individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. However the manager failed to take the necessary action regarding a potential safeguarding incident potentially placing individuals at risk. EVIDENCE: The home has complaints procedure in place that tell people how they can make a complaint and the response they can expect in terms of timescales. We looked at the complaints log and found that no complaints had been made about the service. We spoke with two individuals about what they would do if they were unhappy about anything and they told us “would speak to one of the staff” another individual said they would talk “with the manager she would do something”. Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 16 There are adult protection policies and procedures in place and training records we looked at showed that staff have completed Safeguarding training. The acting manager told us that she had dismissed a member of staff following an incident with an individual who lives in the home. This incident in our view could be seen as a Safeguarding Incident amounting to verbal abuse. However we were not advised of this incident or referral made to the local authority under the Safeguarding Adults arrangements. Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 home provides a safe and hygienic environment for people who live in the home and staff. However the home must make sure that water temperatures are controlled at the appropriate temperature so that individuals are not placed at risk of scalding. People who live and work in the home benefit from a warm, welcoming and well-maintained environment. EVIDENCE: In looking around the home there were areas such as lounge and dining room which were in our view of a good standard and of a homely appearance. However we noted that some areas of the home specifically some of the bedrooms would benefit from updating in terms of decorating and furniture. In one room the wardrobe door had blue tack to keep the door closed and was Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 18 rather shabby in appearance. We were also advised that the home has retained a smoking room and this had no internal ventilation and was also used when the hairdresser visited the home and was not in our view a pleasant and suitable environment for individuals to sit in whilst having their hair done. We were advised by a relative during our visit of the high temperature in an individual’s room this was checked during our visit and found to be above the recommended temperature of 43degrees. We discussed this with the maintenance and acting manager and they were looking at ensuring the temperature of water in the home for room meets the required level. There was no evidence of pre-set valves being fitted. All areas of the home that were seen by us during our visit were clean and individuals we spoke with said the home “was well kept” “always clean”. The home has infection control procedures and guidance in place. Staff have access to protective clothing where this is needed however in looking at training records there was no evidence that staff have undertaken specific infection control training. Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 provides the necessary staffing so that the care needs of individuals can be met. The recruitment practices of the home fail to undertake the necessary checks and potentially place people who live in the home at risk. Staff training is provided so that staff have the necessary skills and knowledge to meet the needs of individuals in a competent manner however there are significant gaps in training where staff have not received the required level of training. EVIDENCE: The acting manager advised us that changes have been made regarding the level of staffing in the home. There are now 3 staff on duty am and pm one being a new post to cover kitchen duties from 2pm to 6pm which means that care staff do not have to undertake kitchen duties during this period which previously was the case. There is also a senior carer on duty. We looked at timesheets for staff over period of 2 months and found that staff levels had been at this level during this period. We also noted that the home doesn’t employ laundry staff and care staff undertakes this task. Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 20 The home has two staff on duty at night 8am to 8pm our understanding was that they are waking staff however we were informed anonymously that one of these staff sleeps in the lounge during the night time. The acting manager told us the night care arrangements in her view were that both were waking night though she was aware of incident where staff had slept during this period. The acting manager had at that time taken action regarding night staff remaining awake at all times. We requested at the time of our visit on the 1st June that the acting manager undertake spot checks of night staff and establish clearly with staff that their role is too act as waking night. We have not been advised as requested (at time of our visit and in letter sent 24/06/09) of the results of these spot checks This would in our view be necessary to meet the needs of individuals who live in the home. One individual told us “haven’t felt neglected, getting the care I need” and another “the staff are there if you want them”. A staff member told us “its not a struggle with the staff we have”. We looked at 5 staff recruitment records and found that Criminal Record Bureau and POVA1st checks had been undertaken as part of the recruitment process. However we found that for one individual there was no previous employer reference (this had been a care home), for another individual there was request for reference from previous employer who again was care home but this had not been received and no record as to action taken to establish why this was. For three of the individual two references had been received and full application form had been completed. Application form for one individual did not give full employment history and for another there were no dates of employment only year. On our previous visit and again on this visit we looked at a number of staff training records, there was no training audit in place or matrix providing the full training needs and records of staff. In total we looked at records for 15 individuals over these two visit to the home. We found that for three individuals there was no training record. For the remaining we found that other then two all had completed the “mandatory” training i.e. Moving and Handling, Safeguarding, Fire safety. The two individuals had not completed Moving and Handling, Safeguarding. In addition some staff had completed Food Hygiene (6), First Aid (7). Only one member of staff had completed Infection control training. There was no evidence of training around specific conditions such as mental health awareness, dementia, stroke care, and epilepsy. Although there is currently an individual living in the home who has this condition. Staff have not undertaken Mental Capacity Act training. Staff are currently undertaking medication training. Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 acting manager whilst having extensive experience and illustrating a level of competence and professionalism failed to act in the required way when dealing with a Safeguarding Incident potentially placing individuals who live in the home or other homes at risk. The health and safety arrangements are adequate however the failure to address the failures in relation to fire alarm system places people who live and work in the home at risk. EVIDENCE: Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 22 The manager has extensive experience of managing a care home having managed Grandada House for 12 years and since March 2009 has been acting manager for Cleevedon Court. In talking with individuals who live in the home there was positive comments about her approach “she’s very good” “we can talk to her”. Staff reported that since Ms J Kendrick working in the home there have been positive changes to working arrangements. There had previously been a history of poor staffing arrangements and lack of management (due to sickness) and this has now improved. Staff said, “it was very unsettling and staffing was not as it should be” but “a lot has now improved” “more structure and instructions for residents, more information” “communication has improved” “clearer expectations”. As stated under Complaints and Protection the manager failed to act as required in referring a Safeguarding incident to the appropriate authority for investigation. We were also not advised of this incident immediately and received notificationon on the 13th June and the incident occurred on the 21st April. It is noted that the staff member concerned was dismissed immediately. The home has quality monitoring arrangements in place where they can look at the quality of the service they are providing however there was no evidence that since our last inspection any review of the care, policies and procedures had taken place. No residents meetings are held in the home however the acting manager said she was looking at this happening. We looked at records relating to the use of individuals money by staff to purchase items or services such as chiropody or hairdressing. Where money had been given to individuals there was the signature of the individual or two members of staff and receipts for items purchased. However there was no receipt or invoicing arrangements for chiropody or hairdressing services. We had been informed about the lack of smoke alarms linked to the fire alarm system in the home we informed the Avon Fire and Rescue Safety Officer of this. They have carried out a visit to the home and issued a notice telling the home this must be addressed. However it is noted that a previous order had been issued by the fire service in April 2008 regarding this matter. On our visit we also looked at this arrangement in the home and found that one room had no fitted fire alarm this was rectified by the end of our visit. We looked at maintenance records for the home and found that the lift had been service in December 2008 and other equipment used in the home such as hoists had also been serviced over the past year. Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X 2 3 STAFFING Standard No Score 27 3 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13 (5) Requirement The acting manager to make sure that there are suitable arrangements to provide a safe system for moving and handling of individuals who live in the home. This was the subject of a previous requirement from our inspection in September 2008. (This refers to undertaking moving and handling assessments for all individuals who live in the home.) The acting manager to make sure there are arrangements for individuals who live in the home to receive where necessary, treatment, advice and other services from any health care professional. This refers to the need to make sure individuals receive treatment on a regular basis from a chiropodist and this is recorded and where this is refused again recorded. In addition where individuals are identified at risk of developing breakdown of skin integrity or where this occurs advice be sought from the appropriate DS0000070055.V376060.R01.S.doc Timescale for action 30/07/09 2. OP8 13 (1) (b) 09/07/09 Clevedon Court Residential Home Version 5.2 Page 25 3. OP8 12 4. OP8 12 5 OP38 23 (2) (c) 6 OP9 13 (2) health professional as to treatment and care needs in this regard. This information to be part of the individuals care plan. The acting manager shall make sure that the care home is conducted so as to promote and make proper provision for the health and welfare of those that live in the home. This refers to establish the need to take action where individual refuse health services such as chiropody and as a consequence place their health at risk. The acting manager shall make sure that the care home is conducted so as to make proper provision for the health and welfare of individuals who live in the home. This refers to the need to undertake and use recognised tool for the assessment of individuals skin integrity, nutritional needs and the identifying the level of risk in these care areas. To have in place evidence for the use of bed rails and consent for their use from the individual or their representative and GP. The acting manager shall make sure that equipment provided at the care home for use by individuals is maintained in good working order. This refers to the use of bed rails and associated equipment (bumpers) and the monitoring of their use in terms of health and safety. We would recommend referring to the Department of Health guidance for the use of bed rails note the use of term bed rails not “cot sides”. The acting manager to make sure that there are DS0000070055.V376060.R01.S.doc 09/07/09 09/07/09 09/07/09 09/07/09 Page 26 Clevedon Court Residential Home Version 5.2 7 OP18 10 (3) 8 OP29 19 arrangements for the recording, handling, safe administration of medicines received into the care home. This refers to ceasing the use of pots when administering medication rather then giving to individuals directly from packs. To making sure that administering records accurately record the giving of medication and there are no gaps in this recording. That where changes are made on the administering record this is signed by two staff members. Further that unused medication is returned at the earliest opportunity, that controlled drugs are stored in separate secure storage at all times. The acting manager shall undertake from time to time such training as is appropriate to ensure that he/she has the experience and skills necessary for managing the care home. This refers to the manager undertaking Safeguarding training to ensure she has the necessary knowledge to take the required action to protect individuals from abuse. Training to include knowledge about the referral process to the local authority and their Safeguarding policy and procedure. The acting manager shall not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in Paragraph 1 to 7 of Schedule 2. This refers to the taking up of references for individuals specifically where they have previously worked with DS0000070055.V376060.R01.S.doc 30/09/09 09/07/09 Clevedon Court Residential Home Version 5.2 Page 27 9 OP30 18 (1) (c) 10 OP25 13 (4) (c) vulnerable adults this must be written verification as to why the individual ceased to work in that position unless this is not reasonably practicable. The acting manager shall make sure that persons employed to work at the care home receive training appropriate to the work they are to perform. (A requirement was made at our previous inspection regarding staff undertaking Infection Control training.) This refers to the need for staff to undertake “mandatory” training i.e. moving and handling, infection control etc. In addition staff to receive training related to the Mental Capacity Act, Mental Health Awareness, Dementia and other conditions associated with older people or of relevance to the care needs of individuals who live at Cleevedon Court. The acting manager to make sure that unnecessary risks to the health and safety of individuals who live in the home are identified and so far as possible eliminated. This refers to the need to make sure that water temperature is controlled and not above the recommended temperature. 01/12/09 01/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000070055.V376060.R01.S.doc Version 5.2 Page 28 Clevedon Court Residential Home 1 Standard OP19 Undertake audit of the homes environment with regard to need for re-decoration and replacing of furniture and put in place action plan to address identified needs for improvement. To include reviewing use of smokers room as hairdresser room. Undertake audit of training needs of staff and put in place action plan for addressing identified training needs. Formulate training matrix which clearly identify training needs of individuals and need for refresher or update training. Undertake quality assurance exercise involving where possible individuals who live in the home and their representative/professionals who visit the home. This to be undertaken within the next 6 months as evidence of improvement and maintaining of a quality service to individuals who live in the home. 2 OP30 3 OP33 Clevedon Court Residential Home DS0000070055.V376060.R01.S.doc Version 5.2 Page 29 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: 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. 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