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Inspection on 03/03/09 for College House Residential Home

Also see our care home review for College House Residential Home for more information

This inspection was carried out on 3rd March 2009.

CSCI 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Key inspection report CARE HOMES FOR OLDER PEOPLE College House Residential Home Berrington Road Tenbury Wells Worcestershire WR15 8EJ Lead Inspector Denise Reynolds Unannounced Inspection 3rd March 2009 11:20 DS0000064821.V374360.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. DS0000064821.V374360.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 DS0000064821.V374360.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service College House Residential Home Address Berrington Road Tenbury Wells Worcestershire WR15 8EJ 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) 01584 810270 01584 811822 Oaktree Care Ltd Manager post vacant Care Home 13 Category(ies) of Dementia - over 65 years of age (13), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (13), Old age, not falling within any other category (13), Physical disability over 65 years of age (13), Sensory Impairment over 65 years of age (13) DS0000064821.V374360.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories:old age, not falling within any other category (OP) 13; physical disability over the age of 65 years (PD(E)) 13; mental disorder over the age of 65 years (MD(E)) 13; dementia over the age of 65 years (DE(E))13;sensory impairment over 65 years old (SI(E)) 13. 9th September 2008 Date of last inspection Brief Description of the Service: College House is situated amongst mainly traditional houses and cottages in the town of Tenbury Wells. The house dates back to 1698 and has been updated and extended over the years without losing the feel of an old country town house. The house has pretty gardens and is within easy walking distance of the shops and local amenities. The Home is part of the community and many people who live there, and staff, come from the local area. The Home is small in comparison with many care homes and still looks and feels like someone’s house; this helps to give it a homely atmosphere. The owner is registered in respect of the home to provide care for up to thirteen older people who need help with personal care such as washing, dressing, bathing etc; it also has registration which allows the Home to accept people who have dementia related care needs and physical disabilities. College House provides a small amount of day care and occasional short stays when they have vacancies. The Home also provides warden type support to some people living in adjacent bungalows. The day care and bungalows are not regulated by us as they are not covered by the Care Standards Act 2000 although we do mention these in our report. When we did our inspection the Home did not have a registered manager. An acting manager was in post but we have since been informed that she has left. Information about the fees charged by College House should be requested from the Home. The Home had a copy of our last inspection report in the home. DS0000064821.V374360.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. We, the Commission, carried out this key inspection without telling the home we were going. A key inspection is one in which we look at aspects of the service that are important to people using it and check the quality of the care provided. This was the second key inspection of the home during 2008/09; this was because the home was rated as 0 stars following the first inspection in September 2008. Soon after the September 2008 inspection, the company that runs the home was taken over by a new owner, Vin Hukkeri. Mr Hukkeri sent us an improvement plan to tell us what action he would be taking to deal with the requirements following the inspection. We went back and inspected the home again in December 2008. At this inspection we found that some improvements had been made and other work was planned. We did this latest key inspection over the course of a day and followed up some things the next day when we went back to inspect the domiciliary care agency that is run from the home. In our planning for the inspection we reviewed all of the information we have gathered since the last key inspection. This included the outcome of the random inspection in December and an Annual Quality Assurance Assessment (AQAA) sent to us by Mr Hukkeri in December. The AQAA is a document that care providers must fill in annually to tell us how the service is being run and telling us what they do well, what they know they need to do better and what their plans for improving the service are. Before we did the inspection we sent survey forms to people who live in the home and to staff; we took the information people wrote in these to help us get a picture of their views of the home. During the inspection, we spoke with a number of people who live in the home and with the new acting manager, Julie Hipkiss (who has since left the home), with four staff and with Mr Hukkeri. During the inspection we observed the daily life of the home and how staff assist people living there. We made observations about things we saw around the building and looked at various records. These included care records, staff files and documentation to do with the running and upkeep of the building and equipment. DS0000064821.V374360.R01.S.doc Version 5.2 Page 6 Because the service is 0 star rated, Worcestershire Council are also closely involved in monitoring the service at the home and there have been meetings with the Commission, staff from the Council and Mr Hukkeri since he took over at College House. We took information from these discussions into account as well. What the service does well: College House is a relatively small care home which has a homely atmosphere. Its central location in the town of Tenbury means it is ideal for local people who wish to remain in the heart of their community. The house is very domestic in the way it is furnished and decorated which helps make it comfortable for people. The gardens are pretty and well maintained so that people have a pleasant place to sit in good weather. What has improved since the last inspection? There have been some improvements at the home but this has not progressed as quickly as we expected. Mr Hukkeri says that he also hoped to have achieved more by the time we did this inspection. Mr Hukkeri has worked in a co-operative and constructive way with the Commission and with Worcestershire Council and has assured us that he will continue to work to improve things at College House. People living at the home now have written plans describing the care they need. There is still room for improvement with these to make sure they contain enough detail and guidance for staff but the foundations for this are now there. People who live in shared rooms at the home now have screening by their beds and washbasins so they can wash and dress with improved privacy. Some improvements have been made to the quality of food provided and people are being offered a choice of food more of the time. It is important that these improvements continue. Mr Hukkeri has made improvements to the premises; for example a new central heating boiler has been installed. A new porch erected at the front DS0000064821.V374360.R01.S.doc Version 5.2 Page 7 entrance helps improve privacy for people in the rooms immediately adjacent to the front door. General refurbishment of flooring and décor has been started and the call bell system has been improved. There have also been improvements in the way that infection control risks are dealt with at the home and staff have had training about this. The laundry was being kept tidier; it was better organised and cleaning chemicals were safely stored away Improvements have been made in the processes used when new staff are recruited although further developments are needed to make the process more thorough and reliable. Plans are in progress for improving the training of staff at the home. Some training in essential topics like safeguarding and infection control has already been started. Mr Hukkeri had a meeting planned with Worcestershire Councils training branch to discuss the training needs of the staff group. This will help him make plans for an ongoing training programme. Proper records are now kept for people who have personal spending money looked after for them at the home. This means that their money and any spending on their behalf are now accounted for. What they could do better: Some of the things we found at this inspection had a direct effect on the health, safety, comfort and well being of people living in the home. Because of this we sent a letter to Mr Hukkeri prior to this report being written to make sure he knew about things that needed urgent action. Mr Hukkeri sent us a written response telling us the action he had already taken, or was planning to take to put these things right. Whilst there is now written information about the care people need (care plans), more work is needed to make sure these have all the necessary information. In the past the home did not have detailed information to give staff guidance and instruction about the correct care for each person. It will be important for Mr Hukkeri to ensure that staff use the care plans effectively as working tools to help make sure people get the correct care and do not view them simply as paperwork. A solution still needs to be found for the lack of private space for staff handover discussions, staff meetings and training; the dining room is used for this now which means that discussions can be overheard. DS0000064821.V374360.R01.S.doc Version 5.2 Page 8 The way medication is managed needs to be improved to ensure that the systems in place are reliable and safe. Although improvements had been made in the way staff are recruited, the paperwork for applicants needs to be checked more thoroughly to make sure it is complete. The recruitment policy needs to be implemented properly and the records need to be improved to provide evidence that the correct procedures have been followed. Staffing arrangements need to be reviewed to make sure the number of staff on duty and how they are deployed is adequate for the number of people using the service and the level of their care needs. Staffing levels also need to take into account the support provided to the occupants of the adjacent bungalows which are linked to the home by an alarm call system. Staff training needs to be better organised and planned to make sure that the knowledge and skills of the staff team continue to be developed. Records of staff training need to be set up that help in this planning process by providing an overview of staff training, including any due dates for refresher training. Staff need to have more training in care related topics, particularly dementia training. The staff team have worked on through changes of management, a change of owner and a lot of uncertainty. We found that staff morale was low and consider that the lack of consistent leadership will have contributed to this. The management arrangements at the home have been unstable for over a year with two changes of manager up to the date of our inspection and a further change notified to us since the inspection. An experienced and effective manager is needed to achieve the necessary changes and provide strong leadership at College House. Mr Hukkeri needs to establish a comprehensive system for finding out whether people are satisfied with the service and to give them the chance to highlight any improvements needed. 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. DS0000064821.V374360.R01.S.doc Version 5.2 Page 9 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 DS0000064821.V374360.R01.S.doc Version 5.2 Page 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving to College House are now more likely to have the care they need properly checked before they arrive. This means that staff will have the information they need to provide the correct care. EVIDENCE: No new people have moved into the home since we did our previous key inspection. Since then, paperwork has been introduced for staff to use to record the care needs, wishes and preferences of prospective new residents. This covers the expected areas and will help staff to make sure they know what care a person needs so they can be sure they are able to provide this at the home. The new owner of the company knows that this is an essential part DS0000064821.V374360.R01.S.doc Version 5.2 Page 11 of the preparation for someone new being accommodated at the home. The work being done to improve care plans at the home should help ensure that people are cared for correctly when they arrive. In a survey one person who had moved to the home before Mr Hukkeri took over commented ‘ I am delighted with the home the only comment I could make is that we were not introduced to staff or given any itinerary. This is a useful comment to consider when introducing people to the home in future. In his AQAA Mr Hukerri recognised the need for improvements in the way information is gathered about prospective new residents and includes this as one of his plans for the next year. DS0000064821.V374360.R01.S.doc Version 5.2 Page 12 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. People who live at the home may not always have their needs met in the correct way or in manner that shows sufficient respect for their dignity. EVIDENCE: In his AQAA Mr Hukkeri told us about some of the improvements that were underway at the home, including the introduction of detailed plans for peoples care. He also highlighted areas where more work is needed to make sure they can meet peoples needs correctly at all times. The improvements he plans include more staff training and continued improvement of the care records. In the surveys, the replies showed that most people at the home and their families are happy with the care provided at the home and feel they are DS0000064821.V374360.R01.S.doc Version 5.2 Page 13 treated well by staff. One person wrote - The manager and through her, the staff see my mother not only as another person to be fed and cared for physically; they have striven to get to know her character and preferences. At the same time they have encouraged and acted positively on measures to improve her mobility and mental awareness. I have been given time to discuss my mothers needs and have been informed of progress and changes. My mother seems very content and I am very grateful for the care given to her. I can feel comfortable with her being at College House.’ We spoke to two local health professionals who described a good working relationship with the home and told us that they are generally happy with communication with staff and that their instructions are acted on. Staff surveys showed that staff try hard to do a good job and provide people with the right care, although some said they do not always have the time they need to do things as well as they would like. These positive views show an underlying desire by staff to look after people well. However, in the months leading up to our inspection we received information about some things at the home that were less positive. In one case it was alleged that a person had been spoken to harshly. This was dealt with under local multi agency arrangements after the owner told us he had done an investigation. We say more about this in the section of our report about complaints and protection. In another case we were told of a number of concerns about poor care practice such as people not having their teeth cleaned, poor moving and handling practice and beds being left dirty. During our inspection we found evidence to support these concerns. During the morning we walked around the home with the acting manager. We did this because of the information that people are not having their personal care attended to when they get up in the morning. We could see that all but three toothbrushes in the home were dry. Some did not appear to have been used at all and some toothpaste tubes were crusted over. We also saw that some people had dry bars of soap on their washbasins or no soap at all. We are concerned that this indicates that people may not be having their personal care and mouth care attended to. We asked the acting manager to turn back three beds so that we could see how they had been made. One of these had a stained bottom sheet which should have been changed. The other two beds were not made tidily and one of them had a persons nightdress untidily pushed under the pillow rather than carefully folded. This concerned us because it showed a lack of attention to peoples comfort and dignity. DS0000064821.V374360.R01.S.doc Version 5.2 Page 14 We saw two beds where wedges were placed inside the sheets to prevent the people rolling out of bed. One of these people was still in bed, the plastic covered wedge against her and a chair pushed against the side of the bed. When we discussed this with the acting manager we learned that there has been no consultation with other professionals about how the two people can be made safe in bed. This is not a recognised way of making sure a person is safe in bed and might pose a risk to their safety. In addition, having a plastic covered wedge in the bed is probably not very comfortable for the person. We observed staff using underarm holds when moving a resident. This is an unacceptable method of moving and handling and indicates that staff need training in this area. There was no moving and handling assessment in place for the male resident who they were assisting although he has limited mobility. This is likely to be uncomfortable for him and could put him and the staff at risk of hurting themselves. If people have difficulty swallowing it is important that their food is given to them at the consistency that best meets their needs without compromising their enjoyment of their food too much. We learned that people receiving soft diets at College House have not been assessed regarding the correct consistency of soft diet for their needs. We were also told that food is being liquidised together rather than being served in a way that preserves the colour and flavour of each food item. This means that people are deprived of the chance to enjoy the different flavours of the food they are eating. Some peoples care plans refer to monitoring weights but staff confirmed that there are no scales at the home for them to weigh people. Mr Hukkeri told us that he had scales available but had not had chance to deliver them to the home. He promised to do so promptly. We did a brief audit of medication and found unexplained gaps in the medication record charts. Mr Hukkeri subsequently told us that he thought this may relate to a person who goes out to day care three days a week. However, the acting manager did not put this explanation forward at the time we were checking the medication with her. We found evidence that the medication policy for the home was not being followed; for example, the policy refers to the need for care plans to include guidance for staff about medication prescribed as required. This information was not available when we checked the medication. We also found that boxes of medication are not being dated when opened although this is also covered in the medication policy. We found that progress was being made in improving the structure and content of the written information about each persons care needs (their care plan). A new deputy manager had been at the home for a week and she had been asked to spend her time working on these plans while waiting for her full criminal records check to arrive. While we were at the home we saw her checking with a person living at the home and his relative regarding the DS0000064821.V374360.R01.S.doc Version 5.2 Page 15 content of his care plan. They were pleased that they were being consulted in this depth because this had not happened previously. We had some discussions with the deputy about the content of care plans and the importance of them putting the person concerned at the heart of the content ie so they are for the person, not just about them. DS0000064821.V374360.R01.S.doc Version 5.2 Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home could be more involved in decisions about all aspects of daily life including how they might prefer to spend their days, activities and the choice of food. EVIDENCE: In his AQAA Mr Hukkeri gave us information about positive aspects of daily life at he home. He told us the home has a warm and friendly atmosphere with helpful and friendly staff and that relatives are encouraged and welcomed in the home. He described the work being done by a member of staff now employed to run activities, these include arts and crafts, physical activities, and social events such as bingo and quiz sessions. During our inspection we saw a group of residents taking part in a knitting DS0000064821.V374360.R01.S.doc Version 5.2 Page 17 circle with the activity organiser. This was a very cheerful session and we heard people laughing and chatting. The activity worker told us that she tries to give residents variety and keeps a record of what the activity is each day. In the surveys people said that they always or usually had activities to do that they enjoy and one person commented that there is more to do now than before. We noted that the care records contained very little information about the way people like to spend their day or what activities they might enjoy. In his AQAA Mr Hukkeri recognises the need to provide activities tailored to the individual preferences of people at the home in addition to the organised group activities. He said this is an area he will improve in the coming year. He also told us that he wants to make arrangements for more regular visits by local clergy and to set up residents meetings. These will all be positive steps which will improve the quality of life for people at College House. Mr Hukkeri also confirmed that improvements had been made in the quality and choice of food provided since that last inspection. People who sent surveys to us indicated that they were generally satisfied with the meals at the home. During the inspection we got mixed information from staff we spoke to. All agreed that the practice of using cooking margarine as spread on bread and toast had been stopped and that there was more fresh food than before. However, mixed views were expressed about the overall quality and quantity of food and the choice provided. We did the inspection at a time when one cook was due to leave and another was waiting for pre-employment checks before starting work. It will be essential for Mr Hukkeri to work with the new cook to make sure that food provided is of a consistently good quality and that people are offered a choice. In his AQAA he indicates that he wants to involve people who live in the home more in planning menus; this will be a positive step. One specific area of food that needs to be improved is how people who have a soft or pureed diet have their meal served. The cook told us that all the items in each meal are liquidised together. This is not good practice. Soft diets should be served with each food separate. This is so people can still enjoy the taste and texture of different foods and so that the meal looks as much like other peoples as possible. Visitors are made welcome at the home but one wrote in a survey that it is hard to know who all the staff are and would like something done to make this easier. DS0000064821.V374360.R01.S.doc Version 5.2 Page 18 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): 16, 18 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. People who live in the home know they can tell the owner if they are not satisfied with their care and staff are aware of how to recognise abuse. However, the home does not have strong procedures to make sure protection arrangements are dealt with correctly. EVIDENCE: Most of the people who sent surveys to us said they know how they can make a complaint if they need to and we saw that information about the procedure was displayed in the home. No complaints had been made to the home since our previous key inspection but one had been made to us through the multi agency safeguarding procedures (we have already said what this was in the personal care section of the report). Mr Hukerri said in his AQAA that he wants to make sure residents and relatives are all aware of the complaints procedure. Since we inspected the home in October staff have received training about safeguarding (adult protection) procedures. This was done by Mr Hukkeri using an off the shelf DVD. We suggest that this is built on by arranging DS0000064821.V374360.R01.S.doc Version 5.2 Page 19 further training with Worcestershire Council. This is so that staff have knowledge about how local safeguarding procedures work. The acting manager was unclear about how to make contact with the local authority regarding safeguarding matters although we saw that this information was displayed on a notice board. Prior to this inspection Mr Hukkeri sent us a copy of one of his monthly visit reports. This contained information about an allegation of abuse that Mr Hukkeri had investigated internally. We referred this matter to Worcestershire Council under local safeguarding arrangements and a safeguarding meeting was held with Mr Hukkeri to discuss what had happened and the action he had taken. The Council and the Commission explained to Mr Hukkeri that he should have referred this incident as a safeguarding matter straight away, not just dealt with it himself. The local procedures are there to deal with allegations of abuse to protect people who use services. The local policy makes it clear that care services must follow these procedures. This is to make sure any investigation is done by the most appropriate agency (eg police, social services, CQC or the owner of the home). Mr Hukkeri accepted what was said and indicated that he had learned from this episode. Staff recruitment has been done more carefully since we inspected in October but the records are not well organised and the information provided by prospective staff in their application forms and in their interviews needs to be more detailed. This is so the home has good information to help them decide whether to appoint a person and evidence for the future about how a decision was reached. DS0000064821.V374360.R01.S.doc Version 5.2 Page 20 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): 19, 26 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. People using the service live in a comfortable, clean house. Further adaptations and improvements are needed to improve the overall facilities including access and security. EVIDENCE: Since taking over the home Mr Hukkeri has made a number of improvements to the premises. These include • New gas boiler • New carpets in some areas • New floorings in some bathrooms and toilets DS0000064821.V374360.R01.S.doc Version 5.2 Page 21 • • • • Thermostatic valves fitted to basins and baths to regulate hot water temperatures The call bell system has been supplemented by staff pagers so that staff hear the call bell wherever they are in the building Privacy curtains have been provided in shared rooms The laundry was being kept tidier; it was better organised and cleaning chemicals were safely stored away In his AQAA Nr Hukkeri told us that he plans to continue a programme of redecoration this year. Everyone who sent us a survey said that the home is always fresh and clean. One person commented - the comments made by other people visiting Mum is that it is clean and smells like home not like a home During this inspection we became aware of the limitations of the passenger lift. The lift is very small and can only comfortably accommodate one person at a time, possibly two. There is no room for a walking frame or wheelchair in the lift. This has implications for deciding whether people can be accommodated in rooms on the first floor and must be taken into account when considering the needs of prospective residents. We know that one person has fallen down stairs because they were frightened of going in the lift alone and that staff are using a chair to sit a resident on in the lift because he is unable to stand. We have told Mr Hukkeri that he must carry out a risk assessment for each person who needs to use the lift indicating what measures need to be taken to reduce any risks to them in doing so, including whether they need to be accompanied in the lift by staff. Part of the accommodation is situated in a separate annexe. The annexe contains two residents bedrooms and the offices of the care home and domiciliary care agency. To get to it you have to go outside the main home for a distance of about 4 metres. Access is by a single action lock with a turn knob on the inside. Although when locked this is secure from outside, there is a risk of one of the two bungalow occupants leaving and being outside at night. Arrangements were being made by Mr Hukkeri for improved security to be provided to this entrance. In the AQAA he said that digital locks are being fitted and at the inspection he confirmed that he is getting further advice from a security firm and from the fire service. He recognises that any solution must provide security and privacy for residents, ease of access for staff and safety in the event of an accident or fire. We believe Mr Hukkeri also needs to give thought to improving the access from the main home to the annexe. This is because at present anyone going between the house and annexe has to go outside to do so; this is clearly a problem in bad weather. We are also concerned that night staff have to go outside at night to check that the people in the annexe are alright. DS0000064821.V374360.R01.S.doc Version 5.2 Page 22 The inner front door was being locked with a deadlock and the key was being placed on top of the adjacent bedroom doorframe. This carries risks in the event of a fire. DS0000064821.V374360.R01.S.doc Version 5.2 Page 23 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): 27, 28, 29, 30 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. People using the service feel confident in the support they get from staff. Staff training is improving but people living in the home do not have the benefit of a well organised team with effective leadership. EVIDENCE: Staff recruitment has been done more carefully since we inspected in October. For example, we saw information to show that two new staff had not started work because all the required checks had not been completed. However, the records were not well organised and there was no evidence to show that information provided by prospective staff in their application forms and in their interviews had been verified or discussed with them. When we asked to look at the recruitment policy and procedure only part of this was available so we couldnt check whether it covered the issues we had identified. The staff rotas show that there are normally three care staff on duty in the morning from 8 until 3pm, two staff from 3pm until 10pm and two staff on DS0000064821.V374360.R01.S.doc Version 5.2 Page 24 duty overnight. At the time of the inspection, the acting managers hours were usually in addition to these hours. The hours worked by the cook do not cover tea time and this meal is prepared and served by the two care staff on duty. Although it is a small home we have concerns that the staffing arrangement at teatime may not always be appropriate, for example if a person living in the home was unwell or had a fall at this time it would be difficult for staff to manage. There are also issues about making sure that safe food hygiene practice can be followed if staff are working in the kitchen part way through a care shift. We have asked Mr Hukkeri to review these arrangements and to consider employing afternoon kitchen staff. When we did the inspection of the domiciliary care agency we learned that staff employed to work in the home provide some support to people living in the adjacent bungalows. The bungalows are linked to the home with a call system and can call the home for assistance in an emergency. We were told that this happens rarely. Nevertheless, we were concerned that when this does happen there would be an impact on staffing levels in the home. This would be of particular concern in the afternoon and evening when only two staff are on duty. There is one regular call made to an occupant of the bungalow; this is to assist a person with their evening medication. Whilst the principle of support to people in the bungalows is a good model for local care provision, the staffing levels at the home when we did this inspection did not take this additional function into account. People who live in the home told us in surveys that there are always staff available when they need them. Staff responses indicted that they dont always feel they have the time they need, for example There doesnt seem to be enough staff in the home especially when it comes to illness/holidays. We do manage most of the time but do have moments of struggle Mr Hukkeri and the acting manager told us at the inspection that they are introducing new staff rotas. Some staff we spoke said they were leaving College House because they were unable to work the proposed new shifts. This was a factor that had contributed to the low staff morale at the home. More staff training has been done since the previous key inspection but the records of this need to be better organised. This is so that the acting manager and Mr Hukkeri can monitor staff training effectively and allocate a training budget accordingly. It was positive to learn that Mr Hukkeri was meeting with the Worcestershire Council training branch to look at the overall training needs for the staff team. In the AQAA Mr Hukkeri told us that the following staff training has been done DS0000064821.V374360.R01.S.doc Version 5.2 Page 25 • • • • • • • • • • Safeguarding of Vulnerable Adults Dignity in Care Moving And Handling Training First Aid Course Introduction to Dementia Care Medicine Management Training Mental Capacity Act 2005 Health and Safety Infection Control Care Planning Mr Hukkeri told us that he intends to make sure that all staff are up to date in mandatory training topics in the coming year and that staff will be encouraged to start NVQ training. Staff surveys also told us that training at the home is improving The new owner and manager are working to get training for all our needs to understand residents needs. As in the past it was nil. If Mr Hukkeri intends to continue to offer a service to people who have care needs due to dementia, staff will need to do more training in this area. The course they did at the end of last year was only an introduction to dementia and this needs to be built on to make sure staff have the knowledge and skills they need. DS0000064821.V374360.R01.S.doc Version 5.2 Page 26 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): 31, 33, 35, 38 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. People in the home cannot be confident that the management of the service is well organised and effective; this is in part due to the lack of consistent management to implement improvements and support staff in improving the service provided. EVIDENCE: DS0000064821.V374360.R01.S.doc Version 5.2 Page 27 Throughout his AQAA Mr Hukkeri told us about the things he has already improved or plans to improve in the year ahead. In a staff survey one person said We are all trying to get our lovely small home back to past owners running and get back on line. Last twelve months have been a struggle - lots of changes, no one listening. We now have a new owner lots of new ideas. We have already have had new improvements. Nothing is too much trouble and we get what we ask for needs of residents. When we did this inspection we did not get such a positive view from the staff we spoke to or from the issues we identified during the inspection. Subsequently, in discussions with Mr Hukkeri he has accepted that progress has been slower than he expected. Since we did this inspection Mr Hukkeri has informed us that the acting manager at that time has left and that at present he is working with the deputy manager to manage the home. This means that the home has had four people in day to day charge in less than two years. During the inspection we found an undercurrent of staff unrest and differences of opinion between staff. We believe this is partly due to the protracted period of change during those two years. One of the concerns staff had was that Mr Hukkeri is not available as often as they feel he should be and that it is hard to arrange to speak to him. It is essential that while there is no registered manager in post at the home Mr Hukkeri ensures he is present and available to people living at the home, and staff as much as possible. This will not only benefit them but will also make sure that he is aware of what is happening in the home from day to day. There is no organised quality assurance system in place at the home yet other than the monthly reports Mr Hukkeri writes as required under Regulation 26. Consultation with everyone involved in the home is particularly important during this time of change and we have made a requirement about this. The records and storage of peoples personal spending money had improved. Clear records had been set up and these showed the details of deposits, spending and balances for the three people concerned. Improvements had been made in respect of safe working practices in a number of areas. For example, storage of cleaning chemicals was safer and there was more protective equipment available for staff to use. Liquid soap and sanitizing hand gel was available in the home and there were paper towels for people to dry their hands. There were a couple of terry towels in two toilets and we pointed this out as a continued cross infection risk. Storage and tidiness throughout the home had improved. Some safety risks remained. We have already described our concerns about these in the report, for example, the risks due to the size of the lift, access and DS0000064821.V374360.R01.S.doc Version 5.2 Page 28 security in the annexe, the fire risk due to the way the front door is locked and the lack of proper assessment of risk for people who may fall out of bed. DS0000064821.V374360.R01.S.doc Version 5.2 Page 29 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 1 DS0000064821.V374360.R01.S.doc Version 5.2 Page 30 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 OP8 Regulation Requirement Timescale for action 11/03/09 2 OP10 3 OP38 Regulation You must take steps to make 12(1) sure that people have their personal care needs (including washing and mouthcare) attended to in the morning and at night. Regulation You must take steps to make 12(4)(a) sure that staff change soiled bed linen and make the beds in a way that shows consideration and respect for the person who will be sleeping in it. Regulation You must take steps to consult 13(4)(c) with other professionals regarding safe and appropriate ways to keep people safe in bed. You must use the results of this consultation as the basis for a risk assessment and care plan to make sure all staff know the correct arrangements for each person. 11/03/09 12/03/09 4 OP38 Regulation You must take steps to put 31/03/09 13(4)(c) moving and handling assessments in place for each person living in the home. These must be done by a suitably qualified and competent person. DS0000064821.V374360.R01.S.doc Version 5.2 Page 31 5 OP8 Regulation 12(1) Regulation 12(1) Regulation 12(1) Regulation 13(2) 6 OP8 7 8 OP8 OP9 9 OP38 Regulation 13(4) (a), (b), (c) 10 OP19 Regulation 23(2)(a) 11 OP19 Regulation 23(4)(a) Regulation 24 12 OP33 This work should be prioritised so that the people at most risk are assessed first. People who need soft diets must be assessed to establish the correct consistency for their individual needs. Soft diets must not be pureed into one item; they must be served so that the flavours of each item are preserved. You must provide the means for staff to check and monitor peoples weight. You must take steps to ensure that medication is administered and recorded correctly at all times so that people in the home can rely on receiving their medication correctly. You must carry out a risk assessment for each person who needs to use the lift indicating what measures need to be taken to reduce any risks to them in doing so, including whether they need to be accompanied in the lift by staff. You must make arrangements to ensure the safety and security of the two people who have their bedrooms in the bungalow annexe whilst maintaining easy access for staff and taking fire safety and deprivation of liberty considerations into account. You must seek guidance from the fire service regarding suitable locking arrangements for the inner front door. You must set up a thorough system for reviewing the quality of the service; this must include consulting people who use the service and their representatives about their views of the service. 31/03/09 12/03/09 12/03/09 12/03/09 31/03/09 31/03/09 31/03/09 31/05/09 DS0000064821.V374360.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP9 Good Practice Recommendations You need to make sure that staff are supported to use the new care plans as working tools that help them provide the correct care. Arrangements for the safe management and administration of medication would be improved by • Making sure all staff are aware of and follow the homes medication policy • Having a robust system for stock control and audit • Having photographs of people living at the Home with their medication records • Having clear written guidance available for staff describing the circumstances in which ‘as required’ medication should be given to an individual • Having clear written guidance for staff describing the circumstances in which homely remedies should be given to an individual; this should include confirmation from the person’s doctor regarding the use of the homely remedy • Dating packs of medication when they are opened and the first dose of mediation is used You need to explore solutions to ensure that staff handovers, meetings and other confidential discussions can be held without compromising the privacy and confidentiality of people who live in the home. You should give consideration to improving staffing arrangements taking into account the support provided to the bungalows and catering arrangements in the afternoon. You need to make sure the recruitment policy and procedure for the home is available and fully implemented. You should also make sure that recruitment records provide a robust audit trail of the recruitment process. You need to make sure that records of staff training provide an effective tool for you to use to monitor staff training needs and identify when refresher training is due. You need to arrange further dementia training to build on the introductory course provided in 2008. DS0000064821.V374360.R01.S.doc Version 5.2 Page 33 3 OP10 4 OP27 5 OP29 6 7 OP30 OP30 8 OP31 You should take urgent steps to recruit a person as manager and to arrange for them to submit an application to be registered with CQC. DS0000064821.V374360.R01.S.doc Version 5.2 Page 34 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT 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. 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. 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