Inspection on 11/02/10 for Cookridge Court and Grange

This inspection was carried out on 11th February 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cookridge Court and Grange 26/08/08

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: Cookridge Court and Grange Iveson Rise West Park Leeds LS16 6NB     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Carol Haj-Najafi     Date: 1 2 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Cookridge Court and Grange Iveson Rise West Park Leeds LS16 6NB 08452710793 01132672644 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.orchardcarehomes.com Orchard Care Homes.Com Limited care home 96 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 96 The registered person may provide the following category of service only: Care Home only - Code PC. To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE, Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Orchard Care Homes.Com Ltd owns and operates Cookridge Court and Grange. The home is situated in the Cookridge area of Leeds close to bus routes and local shops. There are good car parking facilities for visitors and safe garden areas for people to enjoy. The home began to operate in March 2008 and is registered to provide care to ninety-six people of which half may need dementia care. The accommodation is to a high specification and is on three floors that are serviced by passenger lift. All bedrooms are single with en-suite facilities and some have patio doors with direct access to the gardens. There are six separate living areas each with a lounge/dining Care Homes for Older People Page 4 of 36 48 0 Over 65 0 48 Brief description of the care home room and a quiet lounge. This set up makes the smaller living areas more homely and comfortable. Details about the care and services provided can be found in the homes statement of purpose and service user guide and these are available at the home. At the time of the inspection visit in February 2010 the range of fees was £424 to £625. The fees do not include dry cleaning, personal toiletries, hairdressing, private chiropody or fees for a personal phone installation and call charges. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Care Quality Commission (CQC) inspects care homes to make sure they are operating for the benefit and well being of the people who use their service. More information about the inspection process can be found on our website www.cqc.org.uk. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The last key inspection was carried out in August 2008. We carried out this visit because concerns about the service had been raised and we decided it was appropriate to do an early inspection. Before this visit we reviewed the information we had about the home to help us decide what we should do during our inspection. Care Homes for Older People Page 6 of 36 Surveys were given to people who use the service and staff during our visit. Thirteen surveys were returned, two from people who use the service and eleven from staff. Information from the surveys has been included in the report. Two inspectors were at the home over two days. The first visit was from 15:45 to 21:45 and the second visit was the following day from 7:30 to 13:30. We spoke to people who live at the home, visitors, day and night staff, the acting manager, the area manager and two managers who are providing additional support to the home. Some people have limited communication and cannot tell us if they are happy with the care they receive or if their needs are being met so we also observed interaction between staff and people who live at the home. We looked around the home and looked at care plans, risk assessments, daily records and staff records. Feedback was given to the acting manager, area manager and a support manager at the end of our visit. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: The care planning and risk assessment process could be developed to make sure peoples care needs are properly identified. This will make sure peoples needs are recognised and met. Staff could receive more guidance and support to help them understand how peoples specialist needs should be met. One person said staff do not know the special way to deal with (name of person). Concerns were raised that staff do not know how to about meet peoples specialist needs. For example, dementia or a sensory impairment. We saw one example of poor practice. The person needed staff support to walk, two staff were helping them from the dining room to the bathroom after breakfast. The person had no slippers or pyjama bottoms on and their incontinence pad was clearly visible. One visitor gave us an example where they had been told the persons teeth had gone missing but when they looked the teeth were in the bedroom. Some people raised concerns about the laundry service and clothes that had been ruined. One person said they had noticed people wearing other peoples clothes. Better systems could be introduced to make sure people are treated with dignity and respect at all times. On the day of our first visit some people said lunch was poor quality. One person who lives at the home said, We used to say the food is marvellous but we cant say that Care Homes for Older People Page 8 of 36 now. Some people raised concerns that the home sometimes ran out of provisions. Staff told us three days before the inspection the home had run out of milk. People could be offered more varied and nutritious food in sufficient quantities. This will make sure peoples nutritional needs are met. The range and level of activities offered to people could continue to be developed. This will make sure people are stimulated. We saw records in one unit where a person was clearly unhappy and had complained to staff. Over a six week period, nine entries were made where the person had complained about food or the standard of care at the home. These complaints had not been passed onto the acting manager so had not been investigated. Better systems could be introduced to make sure staff pass on concerns and complaints to the management team to investigate. This will make sure people are listened to and their rights are protected. The environment could continue to be developed to meet the needs of people with dementia. The staffing arrangements could be reviewed to make sure there are enough staff to meet the needs of the people living at the home taking into account the size and layout and purpose of the home. This will make sure peoples needs are met. We visited the home over two days and during this time we spoke to four staff who had only been working at the home for a short period of time. One person had worked at the home for three months another person had worked at the home for five weeks. The four staff had not completed an induction programme and had not done some important training. Two staff had never worked in care before. They were all working unsupervised. Staff could receive an induction and training that helps them understand how to care for the people they are supporting. This will make sure peoples needs are met. All staff that support people who live at the home could also receive necessary health and safety training. This will make sure people are safe. The recruitment process could be more robust to make sure previous employment is checked and the right people are employed to work at the home. This will protect people who live at the home. The home could be managed with more care, competency and skill. This will make sure people are safe and their needs are met. The quality of the service could be monitored more closely to make sure people are receiving a satisfactory service. Any changes that are identified in accident records to meet peoples changing needs could be recorded in the persons care plan. This will make sure peoples needs are recognised and met, and people are safe. 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. Care Homes for Older People Page 9 of 36 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs will be assessed before they move into the home, which makes sure their needs are known. Evidence: At the inspection in August 2008 we found that people experience good outcomes in this area and peoples needs are properly assessed before they move into the home. Since October 2009 no one has moved into the home. Admissions to the home were suspended by the local authority because the home was not providing a safe service to the people who were living there. Orchard Care Homes also decided that they would not admit anyone to the home so they could put things right. When we visited the home seventy three people were living at the home although the service is registered to provide a service to ninety six people. Care Homes for Older People Page 12 of 36 Evidence: We talked to one person who moved into Cookridge Court before admissions were suspended. They told us the manager visited them at home and did an assessment to find out what they needed. They said they have settled in well and were satisfied with the admission process. We talked to the area manager who said the home would not be admitting people to the home until they had put things right. We have covered this in more detail later in the report. We looked at two peoples assessment records that moved in after the last inspection. They had assessments that were completed before the person moved into the home. In the main, the assessments contained good information about the type of support they required. People had a document called care needs summary which contained good detail about care needs and the reasons for admission to the home. They also had a document called personal wellbeing, which is a checklist of physical needs and preferences although one persons was not fully completed. For example, it had no information on bathing or showering. One persons care needs were re-assessed following time in hospital. This is good practice but in this case there was little reference to the hospital admission and any changes in the persons care needs. Care Homes for Older People Page 13 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not always receive consistent care which has sometimes resulted in their needs not being properly met and their dignity not being respected. Evidence: We talked to people who live at the home and their relatives. We received mixed feedback. Some people said they are satisfied with the care; others thought the home could improve some aspects of care. Generally, people said the staff are good. Three people who live at the home chatted about the home and they all agreed the staff are wonderful. Another person said, Sometimes the care is excellent because the staff are excellent. Other times staff dont care and cant be bothered. We looked at how some peoples specialist needs were being met because concerns had been raised that sometimes the home were not meeting peoples specialist needs. We got a mixed response from people who live at the home, visitors and staff. Some people thought staff were skilled others thought staff were not skilled enough to understand and care for people with specialist needs. One person who has a specialist health need said staff know what I can eat and what I cant eat and they know who Care Homes for Older People Page 14 of 36 Evidence: has a shower and who has a bath. Another person said staff do not know the special way to deal with (name of person). Concerns were raised about meeting peoples needs who have dementia or a sensory impairment. We did not see any guidance or training for supporting people with a sensory impairment. During our visit we spoke to four staff who had not received an induction and important training. Two of the staff had never worked in care before and were working on their own in a unit and caring for people with dementia. We have covered this in more detail in the staffing section of this report. Two people said it would be better if the home introduced a keyworker system so staff got to know people better. We looked at a complaint that referred to keyworkers and the acting manager had responded and said that a keyworker system would be introduced by December 2009. This had still not been introduced when we did our visit in February 2010. Some people raised concerns about staffing levels and thought that staff did not have enough time to spend with people who live at the home. The home is divided into six units and staff are allocated to work in each of the units. During the night one night staff is allocated to work on each unit and a floating staff covers three units. The night between our visits a night staff had struggled to help one person with their personal care and couldnt get support from the floating staff because they were already covering for another staff in one of the other units. We have covered staffing issues in more detail under the staffing section of the report. Part of the day was spent talking to people and observing the care being given to people. This included how staff interact with people who live at the home. In the main, staff treated people with dignity and respect. We saw a lot of very good practice and some lovely interaction where staff treated people with warmth and kindness. We saw one example of poor practice. The person needed staff support to walk, two staff were helping them from the dining room to the bathroom after breakfast. The person had no slippers or pyjama bottoms on and their incontinence pad was clearly visible. One visitor gave us an example where they had been told the persons teeth had gone missing but when they looked the teeth were in the bedroom. The general appearance of people who live at the home was good. They were dressed appropriately and attention had been given to their personal care. Hairdressers visit on a regular basis. Several people said the hairdressers are very good. People said they can have a bath or shower when they want. Daily records also showed us that people have regular support with personal care. Some people raised concerns about Care Homes for Older People Page 15 of 36 Evidence: the laundry service and clothes that had been ruined. One person said they had noticed people wearing other peoples clothes. People told us the home always make sure they get the medical care they need. One person said, I can see the doctor when I like and the doctor asks if Im happy here, which I am. We saw records that told us peoples health is being monitored. Weight was regularly checked although this was recorded in the communication book rather than individual records. Daily records provided information about the care that people receive. We read details of health appointments, food and fluid intake, personal care and changes in peoples well being. We found that in addition to the individual records staff were making detailed recordings in a communication book. Personal details of people should not be kept together in this way because it does not comply with data protection. Staff had recorded information about people that was inappropriate and other information that should have been followed up with some action. For example staff had written that they had a battle with one person who lives at the home but they didnt provide any more detail. Staff had also written that people had concerns about the standard of care that was being offered and that people said they didnt have enough to eat but these comments were not passed onto management. We received eleven staff surveys. Seven said they usually receive up to date information about people who use the service; four said they always receive up to date information. We received a very mixed response when we asked if the way they share information about the people they care for with other carers and the manager works well. Three staff said always, four staff said usually, two staff said sometimes and one staff said never. People who live at the home did not know they have a care plan that identifies their needs. Two relatives said they have not been involved in care planning. One person said the staff are writing, writing, writing and it goes on and on. Daily records are kept separate from the rest of the individual care records which means that care staff are commenting on care without referring to care plans. Not all staff have free access to the care records. This increases the risk of care needs being overlooked. When we asked a night staff for care records she said she couldnt get them as she didnt have the keys. Care Homes for Older People Page 16 of 36 Evidence: We looked at four peoples care records. These contain a lot of information about peoples needs but they are difficult to follow because the records are divided into many different sections and each section has a combination of care plans and assessments. The area manager said Orchard Care Homes has been working on new style care plans because they have recognised the care plans are not working effectively. They are piloting the new plans and are hoping to have them introduced in their services in the next three months. We looked at the medication systems including administration of medication. We found that there is good medication storage in place and staff who administer medication have completed medication training. Records were completed correctly. Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not offered good quality and nutritionally balanced meals and do not always have enough to eat. Activities have improved so people are having more stimulation but this still needs to be developed further. Evidence: People were relaxed when we visited each unit during the afternoon and evening. Staff were spending time with people and offering activities. One relative said the home has improved since the number of people living in the unit has reduced. They said staff have more time to do activities. Staff said the level of activities has improved especially on the three units for people with dementia although everyone thought activities should be developed further. Two staff surveys suggested the home could offer more activities. One staff survey said, The home ensures that residents are well cared for and that plenty of activities take place that enriches the residents lives. The records of activities demonstrated the limited stimulation and occupation available Care Homes for Older People Page 18 of 36 Evidence: to people. For example, the documented activities included reading books; sitting in the main lounge; hairdresser. However, on the dementia unit we saw staff engage with people in a way that supported them in meaningful activity. For example, people helped set the tables at mealtimes and clear away, discussion during the meal included whether or not people wanted a game of dominoes after tea. The management team said activities are still being developed especially for people in the residential units. The area manager said the new care plans focus more on peoples preferences so will identify what people want to do. Staff said routines are generally flexible although meal times are generally fixed. People can choose when to get up and when to go to bed. When we arrived at 7.30am some people were still in bed other people were up. One person said, I make decisions about what I do. I am a very private person and like to spend time alone, and they respect that. A group of three people talked to us about the home. They said they spend most of their time in the lounge but can spend time in their room if they wish, and they enjoy talking to staff and other people who live at the home. One person said, I cant fault it. The others agreed but one person said they are short of things to do. Relatives said they can spend time in communal areas or in peoples rooms if they wish and visit at anytime. Two relatives said they had been informed by Orchard Care that the home had not been providing a good service and they were introducing better systems to improve the service. We received information before we carried out our inspection that people were not getting enough to eat and sometimes the home is running out of important provisions such as teabags and juice. Serious concerns were also raised during our visit about eating and food in the home. On the day of our first visit some people said lunch was poor quality. One person who lives at the home said, We used to say the food is marvellous but we cant say that now. Another person who lives at the home said, The food is very nice. I get plenty and cant eat it all. Another person said, Im diabetic and they know what I can have and what I cant have. Its all very nice. Some people raised concerns that the home sometimes ran out of provisions. Staff told us three days before the inspection the home had run out of milk. Staff had recorded that two people who live at the home were unhappy because they did not think people were getting enough to eat. One person who has lost weight recently and had been advised to see the GP, raised the same concerns with us during our visit. Care Homes for Older People Page 19 of 36 Evidence: Their care plan said they have an enormous appetite. Five staff surveys told us that food and eating was a concern. When asked what the home could do better we received the following comments. Supply decent food to serve to the residents. I sometimes feel ashamed to serve the meals as I wouldnt eat it myself. Make sure there is enough bread and milk. Residents are continually complaining about the food being poor or a lack of. Over the past few weeks food has been limited. When shifts have been started there is little milk and bread available. There is no access to the kitchen as everything is locked away. Care staff do not have access to provisions held in the main kitchen when catering staff are not at the home. Unit kitchens should be stocked with basic provisions but some staff said this does not always work well. New menus were introduced a few days before our visit. We looked at the menus which were not nutritionally balanced. Several people raised concerns about the menus and said they had not been offered the choices that should be available. For example one person said they had not been offered chicken gougons which was on the menu but just given shepherds pie. Another person said they were not offered soup even though this was on the menu. Four people commented that the menu only had dessert of the day so they didnt know what dessert they were being offered. When we raised concerns with the area manager about food she said the new menus had not been approved by the management of the home and would be withdrawn. She also acknowledged that food had been an on going problem and an area that they needed to address as a matter of urgency. A booklet called Orchard Care Homes Guide to Care is displayed in the entrance of the home and people can take a copy. The booklet states Our menus, offering five choices for every meal, are planned by a professional nutritionist to ensure our residents receive a healthy, varied and interesting diet. The statement is not accurate. We spoke to a staff member who worked in the kitchen. They said they didnt have time to prepare food properly and the meal arrangements were not working well. They said they did not have enough fruit for people and didnt have time to make high calorie smoothies which should be given to people who are at risk because of low weight or weight loss. We observed breakfast being served in each unit. Some people were having cereal and toast when we arrived at 7.30. Other people were not offered cereal and toast Care Homes for Older People Page 20 of 36 Evidence: and had to wait for a cooked breakfast to be brought up from the kitchen. Some people did not have their cooked breakfast until 10.30 and were then offered their main meal of the day at 12:30, which is only a short period of time in between meals. People told us that they were unhappy about the timing of breakfast and that this was not the first time it had been late. Care Homes for Older People Page 21 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and safeguarding processes have improved but on occasions peoples complaints are not dealt with effectively. Evidence: People who live at the home told us they talk to their relatives, staff or management if they are unhappy. One person who lives at the home said, They (the staff) soon notice if something is wrong. People who live at the home and relatives said they know how to make a complaint about the care provided although some people said the care service has not always responded appropriately if they have raised concerns. The complaints procedure was displayed in the home. Staff said they pass on concerns to the management team although we found that this does not always happen. Staff said the management team dealt with issues appropriately. We looked at the complaints record which showed that the acting manager has investigated and responded to complaints they have received. Some complaints were about similar issues- food, staffing and missing clothes. Response letters acknowledged where the complaint is upheld and what they plan to do to make sure similar problems dont happen again. The acting manager said they have addressed some issues but other areas such as staffing take longer to resolve. Care Homes for Older People Page 22 of 36 Evidence: However, not all complaints have been dealt with properly or investigated as a complaint. We saw records in one unit where a person was clearly unhappy and had complained to staff. Over a six week period, nine entries were made where the person had complained about food or the standard of care at the home. These complaints had not been passed onto the acting manager so had not been investigated. The acting manager and area manager agreed to follow these complaints up after the inspection. Some of the concerns that were raised about the home in October 2009 were because they had not passed on important information to CQC or referred safeguarding incidents to the relevant agencies. The management team have worked hard to improve their reporting systems and this has been recognised by professionals who have been working alongside the management team. Since the concerns were brought to the attention of the home several safeguarding incidents have been reported and dealt with appropriately. A safeguarding file contains details of any safeguarding referrals. The acting manager said these are carefully monitored. Management said most staff have completed safeguarding training but acknowledged that not all staff had completed the training. We have covered staff training in the staffing and management section of this report. Care Homes for Older People Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a very comfortable, clean and well organised environment. Evidence: People who live at the home, visitors and staff said the environment is very good. They said the home is always clean and tidy. There are good parking facilities for visitors and safe gardens for people to enjoy in the good weather. The interior is safe to move around with wide corridors for easy movement with wheelchairs and zimmer frames. There is ample equipment and space for people to be assisted with washing and bathing safely. Bedrooms are all single occupancy, en-suite and well equipped and people are encouraged to bring personal belongings to make their rooms more homely. People can have their own telephone installed if they wish. The home is divided into six units, each with their own communal lounge/dining room and a small lounge. These are comfortable areas that make it easy to feel at home and much easier for staff to supervise and interact with people. Themes have been introduced in some of the small lounges. For example one lounge has traditional furniture and equipment such as a hand sewing machine. Some people were sat in the small lounge and said they call it the old time room, then started chatting about jobs Care Homes for Older People Page 24 of 36 Evidence: they used to do before they retired. Three units provide a service to people with dementia. The management team said they are developing these environments to meet good practice standards. Appropriate signage is important for helping people with dementia find their way around the home. The units do not have much signage and many bedroom doors do not have anything to help people identify which is their room. Clinical waste is properly managed and staff wear protective clothing when attending to peoples personal care needs. Hand cleaning facilities are situated throughout the home. Care Homes for Older People Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are not always recruited through a robust recruitment process and when they start working at the home they do not always receive important training or an induction to help them understand the needs of the people they are supporting. Evidence: In the main, people who live at the home and visitors were generally complimentary about the staff that work at the home. People generally thought things had improved because they have recruited more staff and are using less agency staff. One person said, Staff are wonderful. They help me a lot. Another person said, Some are very, very good. Others are not at that standard. The acting manager has reorganised staffing to help provide more consistency. Staff are allocated to work in specific units and said they thought this has improved care because people get to know each other. Staff generally thought the management team had worked hard to improve team work and staff morale although most people thought there was still work to do. We visited the home over two days and during this time we spoke to four staff who had only been working at the home for a short period of time. One person had worked at the home for three months, another person had worked at the home for five weeks. The staff had not completed an induction programme and had not done some Care Homes for Older People Page 26 of 36 Evidence: important training. Two staff had never worked in care before. They were all working unsupervised. Some staff told us they had received enough training, other staff said they had not done enough training. Nine of the eleven staff surveys said they have received enough training, two staff surveys said they have not received enough training. One staff had written in the survey that staff have good training and promotion opportunities. The training matrix that should identify which training courses staff have completed was not up to date. The management team started checking training records during our visit and recognised that some training was not up to date but also found that some staff had completed training and it was not recorded. Some fire training was not up to date. Training for staff was advertised on the office notice board which was due to take place eleven days after after our visit. We could not find evidence that staff had been given training to help them understand some specialist needs. Concerns had been previously raised about deaf and visual impairment awareness. A booklet called Orchard Care Homes Guide to Care is displayed in the entrance of the home and people can take a copy. The booklet states Every employee has an individual training plan and all employees involved in caring hold, or are working towards a relevant NVQ. The home told us 65 of staff hold an NVQ and other staff were going to register for NVQ shortly. Staff did not have individual training plans. People told us they were concerned about staffing levels. Seven staff surveys said sometimes there are enough staff. Three surveys had additional comments about staffing and what could improve. Make sure there are a good amount of staff night and day. Ensure there is enough staff to meet the needs of all residents in the home. Not enough staff. The main concerns related to night staffing levels. One staff works in each of the units and a floating staff works between three units. Night staff help people get ready for bed and when they are with people in their rooms no staff are supervising or checking other people in the unit. For example the night in between our visits, we were told about two incidents that had taken place where night staff did not have enough support to meet peoples needs. Management said they agreed that the home did not have enough staff on a night. One week after the inspection, the acting manager contacted us and said they have increased the staffing levels on a night. Care Homes for Older People Page 27 of 36 Evidence: We looked at the recruitment process for three people that started working at the home in the last four months. Everyone had completed an application form, and criminal record checks and written references were obtained. Each of the files did not have a full employment history. There were gaps in employment history that had not been explored. One person gave employment dates that did not correspond with dates given on a reference. We received several comments that some staff are not right for the job. The following comments were made when we asked what the home could do better: Employ staff that know what they are doing also that are qualified and experienced. Employing people with experience for the position and knowing the people that they employ know how to carry out their role adequately. Provide a mixed age of carers instead of all young people. Make sure the right people are interviewed and offered jobs. Care Homes for Older People Page 28 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team has taken some steps to improve the quality of the service but there are still serious shortfalls that put people at risk of harm. Evidence: In the last few months several concerns have been raised about the home and we received information that told us the home was not being properly managed and people were not receiving a good service. We brought forward our inspection programme because we did not believe the good rating that was awarded to the home after the inspection in 2008 and reviewed in August 2009 accurately reflects the service that is provided now. Issues raised have related to low staffing levels, high turnover of staff and management, poor care planning and risk assessment, insufficient training, lack of understanding of dementia, not passing on information to relevant agencies and other professionals, lack of activities and poor quality food. Care Homes for Older People Page 29 of 36 Evidence: A number of other agencies have been working with the home to help make the necessary improvements. Everyone who lives at the home has or is having a review of their care with either the local authority or Age Concern. The reviews have also highlighted some concerns about the care people are receiving. Orchard Care has increased the management at the home. An acting manager is managing the service but has support from a project manager and another service manager. They are advertising for an experienced manager who will take on the registered managers role. They have also increased the number of deputies that work at the home and provided additional support to help them take on a more managerial role. The area manager has been spending much more time at the home and has been more involved in the day to day running of the service. However, after the inspection we were informed that the area manager is leaving her post, which could lead to a deterioration in the management of the service. We received mixed feedback about the overall management of the home. Some people thought the management team were working well and putting things right. Other people did not think things are being addressed properly. Several people said the acting manager is working very hard and doing a good job. Some concerns were raised about the overall management of the home. The following are comments that we received when we asked what could improve. I dont feel as though I can speak to my manager in confidence. Some staff feel as though they cant approach management as they can be rude and abrupt. I have experienced this myself and I dont feel as though I can speak to them in confidence. We find that other members of staff have found out what you have spoken to management about. The management could be more approachable. Some improvements have been made to the service. For example the home passes on more information and seeks more advice from relevant agencies and other professionals. More staff have been recruited so less agency staff are working at the home. Staffing is generally better organised, staff morale has improved and better systems are in place to make sure more checks are in place. However, during our visit we found a number of issues that had still not been addressed even though some of the problems were identified in October 2009. Additional monitoring systems that have been put in place by Orchard Care were still not producing the desired outcomes. Some people who live at the home and visitors said they thought the problems at the home have occurred because the home has had too many changes in managers and deputies. One person said, Everything is always changing but they dont get it right. Another person said, Why have they waited so long to put things right? Another Care Homes for Older People Page 30 of 36 Evidence: person said, We have seen good improvements but we dont want it to go back. The home has a range of systems in place to check the quality of the service, however, these cannot be effective because problems with the quality of the service are not being identified through the quality monitoring systems. Some staff have not completed important training that that gives them the knowledge to deliver care safely. For example some staff have not completed infection control or food hygiene training but are supporting people with personal care and serving food. It is very important that they know about health and safety and safe working practices. We looked at accident and incident records. These had good information about events that had taken place and action to help prevent a similar incident occurring again. Two forms stated that night checks should be increased to 1hr and 1/2hr because people had fallen out of bed. We checked the night staff checklist which showed they had only been checked every two hours. Care files did not have any information about the changes that were recorded on the accident forms. We looked at some health and safety records and certificates that told us checks are carried out and equipment is tested as recommended by the manufacturer. In November 2008 a food hygiene visit was carried out by the local authority and made three recommendations. The acting manager confirmed that two recommendations were met; one recommendation was not met. A health and safety visit was carried out in July 2009. The acting manager said all recommendations were met. Care Homes for Older People Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 15 16 People must be offered varied and nutritious food in sufficient quantities and at suitable times. This will make peoples nutritional needs are met 30/03/2010 2 27 17 The staffing arrangements must be reviewed to make sure there are enough staff throughout the 24hour period to meet the needs of the people living at the home taking into account the size and layout and purpose of the home. This will make sure peoples needs are met. 30/04/2010 3 30 18 Staff must receive an induction and training that helps them understand how to care for the people they are supporting. This will make sure peoples needs are met. 30/04/2010 Care Homes for Older People Page 33 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 31 10 The home must be managed 30/04/2010 with care, competency and skill. This will make sure people are safe and their needs are met. 5 38 13 All staff that support people who live at the home must receive necessary health and safety training. This will make sure people are safe. 30/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Staff should receive more guidance and support to help them understand how peoples specialist needs should be met. The care planning and risk assessment process should be developed to make sure peoples care needs are properly identified. This will make sure peoples needs are recognised and met. More robust systems should be introduced to make sure people are treated with dignity and respect at all times. The range and level of activities offered to people should continue to be developed. This will make sure people are stimulated. Systems should be introduced to make sure staff pass on concerns and complaints to the management team to investigate. This will make sure people are listened to and their rights are protected. The environment should continue to be developed to meet Page 34 of 36 2 7 3 4 10 12 5 16 6 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations the needs of people with dementia. 7 29 The recruitment process should be more robust to make sure previous employment is checked and the right people are employed to work at the home. This will protect people who live at the home. The quality of the service should be monitored more closely to make sure people are receiving a satisfactory service. Any changes that are identified in accident records to meet peoples changing needs should be recorded in the persons care plan. This will make sure peoples needs are recognised and met, and people are safe. 8 9 33 38 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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