Inspection on 19/06/09 for Cornerways

This inspection was carried out on 19th June 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cornerways 19/12/09

Cornerways 22/06/07

Cornerways 10/08/06

Cornerways 16/01/06

Cornerways 25/07/05

Cornerways 22/02/05

Cornerways 17/08/04

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cornerways Church Lane Kings Worthy Winchester Hampshire SO23 7QS     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kima Sutherland-Dee     Date: 2 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Cornerways Church Lane Kings Worthy Winchester Hampshire SO23 7QS 01962882060 01962884340 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hampshire County Council care home 40 Number of places (if applicable): Under 65 Over 65 0 40 dementia old age, not falling within any other category Additional conditions: 40 0 The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home Cornerways is a registered care home providing personal support and accommodation for up to forty older people. Hampshire County Council owns the home and the manager is Mrs Hazel Hiskett. The home is divided into four units, with ten single bedrooms, a communal lounge, dining room and kitchenette in each unit. Both units on the ground floor accommodate residents who require dementia care. The two remaining units on the first floor accommodate older people. Care Homes for Older People Page 4 of 35 Brief description of the care home The home is surrounded by landscaped gardens. The home is situated in the quiet village of Kingsworthy, three miles away from Winchester. A small local shop is within walking distance from the home. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: We prepared for this inspection by reviewing the previous inspection report and any other information we had received about this home since the last inspection. The last inspection took place on the 22nd June 2007. We also looked at the AQAA which is the homes own assessment of how they are providing outcomes for the residents. The AQAA arrived when we asked for it and it was fully completed. However during this inspection we found several areas where the AQAA was inaccurate and misleading. An inspection took place at the home on the 19th June 2009 and this lasted for 7 hours and 25 minutes. The inspection continued at the home on the 22nd June 2009 for 2 hours and 20 minutes, so a total of 9 hours and 45 minutes was spent at the home. During the inspection we talked to the service manager, the temporary home manager Care Homes for Older People Page 6 of 35 and the deputy manager. The registered manager is not currently in day to day control of the home. We also talked to eight residents about their experience of living at Cornerways and four members of staff who contributed to the inspection. We sampled a number of the records and documents at the home and we observed medication being administered. During the inspection most areas of the home were seen including two of the residents bedrooms after invitations from those residents. What the care home does well: What has improved since the last inspection? What they could do better: The new care plans are not being used or reviewed properly and this means that the information that staff have about how to meet the residents needs is inconsistent. Information about peoples health care needs and risks to them had not always been transfered from the initial assessments into the care plans. The home must improve the way the staff manage medication. The medicines must be given as they are prescribed ,stored safely and recorded properly. It is unclear from the records whether the residents have been given their medication. We are concerned about the infection control procedures at this home as we found examples of poor practice. A number of staff have had infection control training and the equipment is available but the staff are not working to the expected standards. The registered manager has failed to meet a previous requirement to assess the needs of the residents regarding the provision of community access, and arranging suitable trips outside the home. Another requirement has been made at this inspection to make sure that there are enough suitable activities for the residents both inside and outside the home. There are not enough either group or individual activities to keep the residents occupied and interested. This is particularly important for people who do not Care Homes for Older People Page 8 of 35 have family visitors or for those that do not leave the home at all unless staff support them to do so. The registered person needs to ensure that all of the staff receive training in protecting vulnerable adults. The AQAA that the home sent to us was not found to be accurate relating to the level of staff training. This particularly relates to new staff. The AQAA states that they all take part in a number of relevant courses. The records could not demonstrate that the staff had been trained in all of these areas. The registered manager has failed to meet a previous requirement to make sure that the recruitment procedures are followed. At this inspection we still found staff files that had no or only one reference and unexplained gaps in a member of staffs employment history. These recruitment checks should be robust for the protection of the residents. As well as the two requirements that were made at the last inspection and have not been met we are concerned that nine new requirements have been made at this inspection. This would indicate that the home has not been managed effectively. Where the registered person has failed to meet previous requirements the commission will decide what action we need to take to ensure that the registered person complies with the requirements and improves the outcomes for the residents. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be assured that they will be offered the information they need to decide about this home and an opportunity to visit. The staff will assess their needs and decide if those needs can be met at this home. Evidence: The AQAA states that the home gives all prospective residents an opportunity to visit and find out about the home and the services. One new resident said they had come to see the home with a family member. One other person had not been able to visit but their relative was shown around the home and the staff explained the services that are available. New residents are given an information pack which includes the statement of purpose and the service user guide. These documents are displayed around the home on notice boards. The AQAA states that the home works within a range of policies that ensure equlity and diversity and they use this to ensure equlity of opportunity for admissions to the home. Care Homes for Older People Page 11 of 35 Evidence: Before people move to the home a care manager will assess their needs and this is normally followed with a visit by a senior member of staff from the home to discuss these needs. A sample of these pre admission assessments were seen for recently admitted people and they included their health and personal care needs and their preferred routines. One persons relative had supplied a short family history of the resident to help the staff get to know them. The temporary manager stated that after 4 to 6 weeks there is a review of how residents have settled in and at that point they are asked to sign a copy of the terms and conditions at the home. Two samples of these signed documents were seen. The AQAA states that the home has improved in the last twelve months by introducing an admissions pathway . This involves an allocated member of staff welcoming a new resident to help them feel at ease. The AQAA also states that the home plans to improve the documentation and recording on admissions. The two admission assessments that were seen did not include any information on whether the new admissions pathway was used or how it helped the residents to settle in. The assessments did not identify a member of staff that would be welcoming the new admissions. Therefore the admissions process remains the same and although this meets the minimum standards the new pathway that would assist people with the moving in process has not been introduced. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans are inconsistent and they do not give the staff the guidance they need to meet the residents individual needs. The residents health care needs are usually met but again the recording of the residents health needs are inconsistent. The staff are kind to the residents but they do not always demonstrate respect and dignity. The homes medication procedures are not always safe. Evidence: Four care plans were seen and the deputy manager explained that all of the plans have recently been changed to an improved system for recording the residents needs, and how the staff should help to meet those needs. The care plans were inconsistently completed and the deputy manager stated that the plans had been introduced before the staff had been trained to use them. In one instance a resident was identified as having a particular health need but this had not been included in their care plan. Another example is where the staff have identified that a resident needs help to Care Homes for Older People Page 13 of 35 Evidence: maintain their friendships and social contacts but there is no guidance for the staff about how they should help with this. At a recent staff meeting the staff were reminded about their responsibilities to keep the plans up to date and make sure they recorded any changes to the residents needs or health. Again this is inconsistent with some records more up to date than others. The AQAA states that each resident is allocated a key worker who is responsible for writing and updating the plans and making sure the residents are in agreement with the plans. There are no records that identify who this key worker is therefore the residents do not have one named person who is responsible for their care. The AQAA also states that a member of the management team is responsible for checking that the care plans are relevant to each resident. The deputy manager stated that they are now having to go through all the care plans and try to improve the information that the staff use to offer care to the residents. Two of the care plans did have detailed information about the residents preferred routines and when they liked to get up and go to bed, it also recorded what the resident could do for themselves. The staff we talked to did know these peoples needs and they said that they tried to support the residents to maintain their independence. One resident said The staff are good they let me do what I can and they help when they need to. The manager has met a previous requirement to include a photograph of each resident for identification in their care plans. Four care plans included these photographs. The care plans did have details about the residents health and they recorded when appointments took place and any treatments. The plans also record when health professionals such as district nurses and opticians have been involved in the care of the residents. The details about one residents health care needs had not been transfered from the initial assessment onto the care plan. This means that the staff would be unaware that they may have difficulty maintaining their mobility or they were at risk when moving around the home. One plan recorded that one resident should be weighed weekly but this had not been done since the 26th May. The deputy manager said this was incorrect and they should be weighed monthly but the staff had not started to use the new forms yet. This demonstrates the inconsistent recording and documenting of care and health details about each resident. The AQAA states that the service could be better at recording the daily notes about any changes and what care the residents have needed during the day and night. We would agree that this needs improving as again the recording was inconsistent with some staff writing useful details and others Care Homes for Older People Page 14 of 35 Evidence: not recording useful information about the residents. Five out of the eight people we talked with said that the staff were good and kind. We heard the staff speaking to people in a respectful way, but in a way that was based on the tasks the staff were doing rather than a friendly chatty way. One example was at tea time when a member of staff was offering choices of food to the residents. The choice was not on the menu and no explanation was offered but the member of staff just offered a choice and then moved to the next resident. One incident in a corridor indicated that the staff were not fully respectful of the residents at all times. Two members of staff were involved in deflating an air mattress in the corridor, right next to a door. One resident was caught between the door and the corner. The staff were so focused on their task that they appeared unaware of the resident. It took a duty officer who was assisting the inspection to point out the resident and help them to move past the obstruction. Another resident wanted to go to their room but they had to stand in the corridor, again the staff did not seem aware and their attention had to be drawn to the resident before assistance could be offered to guide this person past the obstruction. These incidents demonstrate a lack of understanding of the residents needs and a lack of respect. The more senior staff who were on duty in the office did demonstrate that they understood the needs of the residents and they were friendly and caring. The staff have attended training in basic medication procedures and the senior staff administer medication. The procedures were seen while medication was administered and this was done correctly and safely, except that one resident did not have a medication allergy recorded on their medication chart although it was identified in their care plan. We also found that two medication charts were being kept in the residents files and the deputy manager stated that this was to encourage the staff to record each time they administered prescribed topical creams. We found serious gaps in the records with staff signing for only 18 out of the previous 38 days and another signed for only 12 out of the last 31 days. The senior staff knew this was a problem because the staff were reminded in the staff meeting on the 16th June but they had not monitored this or made improvements. We also found that prescribed topical creams were being left in the residents rooms again as a way of reminding the staff to administer them when they are prescribed. This is unsafe and could be a risk to the residents. Because of these serious concerns an immediate requirement was left with the service manager to ensure that the regulation to safely store, administer and record medication was complied with straight away. Creams were removed from the residents rooms during the visit to the home. Care Homes for Older People Page 15 of 35 Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of suitable activities inside and outside the home is detrimental to the wellbeing of the residents. The home welcomes family and friends visiting the residents. The home assesses the nutritional needs of the residents and provides a range of meals. Improvements to the meals and the way they are served would benefit the residents. Evidence: The home provides a service for people who require personal care and for people who have or may develop dementia. Eight people said there were either no activities or few activities for them. The AQAA stated that We provide a programme of activities, internal and external such as attending day services and vitaliyze ( an exercises programme). During the inspection we found that the activities were limited because the home has not had an activities co-ordinator since 2008. The service is currently trying to employ a member of staff to organise activities. Also no staff are currently qualified to use the mini bus. One member of staff said that the care staff do not always have time to do Care Homes for Older People Page 17 of 35 Evidence: activities with the residents. One of the senior staff on duty in the office added that when activities do take place they are not always recorded. The home did not have a programme of activities but on looking through the diary a number of dates were seen when external entertainers had come to the home, such as singers and shows. Late last year a six week course took place when residents could enjoy clay modeling. On the second visit to the home the temporary manager had arranged for an activity to take place in the morning, this for one group of residents and involved a ball game. In the afternoon a group of seven residents with dementia were sitting around a small lounge/ dining area with the T.V on at a low volume. Four out of the seven people were asleep. At other times people were moving around the corridors. This demonstrates that there were not enough appropriate activities for people to choose from to enable them to keep active and interested. In the staff meeting minutes from the 16th June 2009 a member of staff asked the service manager how they should manage when the residents with dementia are behaving in a way that is challenging. The service manager replied that they would try to involve the day service to assist with activities which would be stimulating for the residents. The service manager explained to the inspector that the residents do not have access to the day service which is attached to the home on the same site. There are a number of residents who are able to attend external activities when these are arranged by families or other agencies. One person went to a regular bingo session and was picked up by a friend, another person attended regular cream teas. The home does have monthly church services and other clergy can attend the home when requested. The staff said that between eight and ten residents choose to attend the services. The residents religious choices are recorded in their care plans. One resident said they had a lot of visitors who are welcome in the home. The home policy and their AQAA state that visitors are welcome at any reasonable time but that the home respects the wishes of the residents not to see visitors if they choose. Visitors sign in the book in the hallway and this showed that a number of residents had family and friends visiting whilst the staff said that some residents did not receive any visitors. For those residents it is even more important that they are able to choose to take part in activities or to go outside the home regularly. Six residents discussed the food at the home, four people said the food was good and two people said it was alright. The AQAA stated that people have their nutritional needs assessed when they move to the home and a sample of these assessments were seen. The AQAA also states that all meals provide a choice The menu at tea time Care Homes for Older People Page 18 of 35 Evidence: consisted of soup or pizza, but the staff were offering people sandwiches as well. Although it is positive that people had more choice, the unexpected changes to the advertised menu could also be confusing for the residents who have dementia. The pizza looked large and very thick and one resident looked at it with surprise and said Thats huge, I dont know if Ill manage that. The member of staff serving the food was kind to the residents but they did not explain the choices or chat to the residents. The staff were keen to get around to all the residents with the food, which is important but they also failed to either hear or answer a question from one resident about the food. The dining room was pleasant and light and the AQAA stated that although people can choose to eat in their rooms the staff encourage them to be sociable in the main dining room. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents can be assured that the staff will follow the complaints procedure and take any complaints seriously and that complaints will be recorded and resolved. The home needs to ensure that all staff are trained in safeguarding vulnerable adults. The staff must ensure that the safeguarding procedures are followed for the protection of the residents. Evidence: Each new resident is given the complaints procedure and two residents said they knew what they could do to make a complaint if they needed to. The complaints procedure is also available in the statement of purpose which is available on notice boards around the home. The registered individuals representative looks at any complaints when they carry out the monthly visits to the home. One new complaint had been recorded since the last inspection and there had been an immediate satisfactory response. We looked at the training records for seven staff and found that three had attended training in the protection of vulnarable adults (safeguarding) in the last year. The senior managers attended a training course in protection in May 2009 and it is their responsibility to then train the care staff. The home manager and staff use the Hampshire county council protection and safguarding policy and one member of staff said they knew where this policy was kept if they needed to use it. The service manager explained that the procedure had not been entirley followed correctly during Care Homes for Older People Page 20 of 35 Evidence: a recent safeguarding incident. This is being investigated and an action plan has been developed to ensure all the staff do follow the procedures in future. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment is suitable for the residents and it is well maintained with recent improvements. The staff are not trained to prevent the spread of infection and they either do not have or are not using the correct infection control equipment. Evidence: The home is purpose built and suitable for the residents needs. The residents were seen using all areas of the home and they had access to a new secure sensory courtyard in the middle of the buildings. The courtyard had seating and sun shades and one resident used this large area for smoking. There is a passenger lift to the first floor and there was a current service certificate available. The residents said they liked their own rooms and they could bring in their own possesions. The care plans had a inventory of each residents belongings and clothes. One room was seen to be well furnished with personal items and photographs. The home has had recent improvements including the two main bathrooms being fitted with hoists to assist people when they have a bath. The home has also been decorated outside and it appears well maintained. The staff are responsible for informing the administrator of any defects and the administrator then contacts the council works department who then come to make Care Homes for Older People Page 22 of 35 Evidence: repairs. It was noted that a light in one downstairs corridor was flashing. A senior carer adjusted the light and a report was made on the day of the inspection. The home was generally fresh and clean and staff are employed to clean the home daily. One residents room did have an unpleasant odour but this was not evident in any other area of the home. The AQAA states that all the staff have infection control training, but the staff records did not reflect this. Out of the seven staff records seen none had been trained to prevent infection in the last year. A senior carer said that soiled waste should be contained in a bag while carried to the sluice room. Another member of staff said that if they could not find the bags they carried soiled waste in a tissue. The service manager agreed that this is not acceptable and there is a risk of infection. We also found that the linen trolley in the downstairs sluice did not have a bag for soiled linen. The bags could not be found and were later seen in the laundry room. Senior staff explained that wipes are used when staff assist the residents to wash or bath but flannels were used when residents were able to look after their own hygiene. They also said that two flannels a day are put in the residents rooms along with clean towels, but more could be supplied if needed. The linen cupboard only had a spare stock of four flannels. The staff meeting in June raised this issue and more flannels were going to be ordered but they had not arrived at the time of the inspection. All of these hygiene issues are of concern because the staff are not being trained to prevent the spread of infection and the equipment is not available or not being used correctly. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff to meet the physical needs of the residents but there are not enough staff to meet all of their social needs. The service is still not ensuring that robust recruitment procedures are followed for the safety of the residents. The staff are not being provided with the training opportunites that they require to meet the residents needs. Evidence: The AQAA states that all staffing levels are determined by the needs of the residents. The duty rota showed that there are always at least five staff on duty as well as ancillary staff such as cleaners and cooks. The deputy manager said that they have recently recruited two new staff members and reduced the number of agency staff that the home uses. They did say that at least one agency member of staff is still needed on most days. The AQAA states that when employing staff they use the general Hampshire county council equality policy and the home does employ people from a range of different racial and cultural groups. The AQAA and the service manager agreed that it has been difficult to recruit staff due to the rural location of the home and because the criminal records bureau checks have taken a long time, therefore people seek work elsewhere. Care Homes for Older People Page 24 of 35 Evidence: The service manager states that they intend to build up a list of regular staff that the residents can get to know and they will then reduce the relience on agency staff. One member of staff said they usually have enough time to meet the needs of the residents. The section in this report on daily life and social activity would indicate that the staff can manage to meet the residents physical care needs but not all of their social needs such as going out or regular activities. The AQAA states that nine staff out of twenty three permanent full and part time staff have a national vocational qualification in care and they are aiming to train fifty percent of the staff team. The previous inspection report made a requirement that the registered person must obtain a full employment history and two writen references before a member of staff starts work at the home. At this inspection we found that out of the three staff files we looked at only one member of staff had all the required checks and two references and a full employment history before they started work. Two other staff files had references missing and unexplained gaps in the employment history. The temporary manager informed us after the inspection that all the references had been sought and that the member of staff did not work in the home between the inspection and the references being obtained. The service manager said that there had been problems with all the information coming to the home from the central human resources team. However the temporary manager stated that it is the registered managers responsibility to ensure that all the correct checks for the protection of the residents are in place prior to a new member of staff starting work. Because the service had not met the previous requirement the commission will decide what action to take to ensure that the residents are safeguarded and the registered person complies with the requirement. A member fo staff who started work at the home last year said that they had had a period of induction for two weeks and they had worked with a more senior member of staff for a period of time. Another member of staff confirmed that they had also had a period of induction to learn about the home. The staff have had a range of training opportunities since the last inspection but the AQAA states that staff have had more training than the records show. Out of the seven training records seen, four people were trained in dementia awareness, four in first aid and four in abuse awareness (POVA). Other staff have trained in fire safety, medication and food hygiene. One member of staff who started work late last year has attended one course in first aid, despite the AQAA stating that new staff are required to train in a range of key skills. Another member of staff said that they had attended a course in manual Care Homes for Older People Page 25 of 35 Evidence: handling but it had only been available several months after they started providing care for the residents. The staff can go and seek advice from one of the duty officers who are based in the homes office between 7.30 a.m and 10 p.m. Two residents praised the staff and said they were very good and kind and they looked after them well. Two people said the staff were alright. Care Homes for Older People Page 26 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has not been managed effectively or in the best interests of the residents. Evidence: The registered manager is not currently in day to day control of the home. The service manager was at the home at the time of the inspection and they have temporarily appointed another registered manager from a different Hampshire county council registered care home. The tempoary manager is qualified and experienced to run the home and they started at the home during the same week as the inspection. The service manager had explained the changes to the staff team at a meeting in June 2009. The service manager has developed an action plan that the temporary manager will put into practice which if carried out should improve the outcomes for the residents. One member of staff said there was a good team of staff at the home who supported each other despite recent difficulties. The staff said they could always seek advice from Care Homes for Older People Page 27 of 35 Evidence: the duty officers who are senior staff based in the homes office. They are responsible for co-ordinating the staff team and monitoring standards in the home. The level of service that is offered to the residents has deteriorated since the last inspection and two of the four previous requirements to improve have not been met as well as nine other requirements being made at this inspection. These requirements are across a range of the outcome areas that affect the care and welfare of the residents. Areas of concern include the lack of consistant care planning, recording and the unsafe medication practices and recording. We are also concerned about the lack of stimulating and interesting activities both inside and outside the home and about the infection control procedures that the staff are using. We also found that the staff are still not being recruited safely for the protection of the residents and that staff training is not as was stated in the homes own assessment(AQAA). These shortfalls would indicate that the home has not been effectively managed. The AQAA states that they use a qaulity assessment tool to seek the views of the residents and to make improvements. The latest results of the quality audit could not be found. Other methods are used to seek the views of the residents and these include a monthly visit to the home by another home manager. They talk to the residents and look at the records but it is not clear if the results have been used to make any improvements to the home or the service. There are regular residents meetings and the minutes were seen for the last two meetings which happen every six weeks. The residents gave their views and opinions and asked for changes but again it is not clear whether these changes have been made. The home is responsible for helping a number of residents to manage small amounts of money. This money is kept securely and there are records to show this is managed correctly. The home has policies for the staff to follow when they deal with money and this includes the non receipt of gifts and money from the residents. The staff said that they have regular supervision to monitor their progress and discuss their roles. The records for two members of staff confirmed that these meetings had taken place. However other supervision records were not available as they are kept in different locations to which the senior staff did not have access. The home is run and managed by Hampshire county council and all of the service and repair of equipment or fittings is contracted centrally through the council. The records showed that the equipment is serviced regularly and current safety certificates were in the home. The fire testing records showed that these were not up to date. No weekly fire alarm tests had taken place since April 2009 and the weekly fire safety checks had stopped on May 5th 2009 so it is not clear if fire safety checks have been carried out. Care Homes for Older People Page 28 of 35 Evidence: The home does have a full fire safety risk assessment and a fire management plan. The home maintains records of accidents and incidents and these were up to date. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 13 16 The provision of community 22/09/2007 activities and access to the community must be reviewed for each resident and arrangements made to provide this activity where appropriate. 2 29 19 Schedule 2 The home must ensure that they obtain an employment history and two written references before a member of staff commences work in the home. 01/08/2008 Care Homes for Older People Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must 06/07/2009 make suitable arrangements for the recording,handling, safe keeping and safe administration of medicines. All medicines must be stored, administered and recorded safely. Allergies must be recorded in the appropriate records. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must 31/07/2009 prepare a written plan in consultation with the service users. This plan must detail how the service users needs in respect to their health and welfare are to be met. The plan must be kept under regular review. The plan must be revised when required and the service user should be kept informed of any changes to their plan. The care plans must record all of the service users Care Homes for Older People Page 31 of 35 needs and how the staff should meet those needs including health care. Regular reviews must take place. 2 12 12 The registered person must ensure that for the prupose of providing care and making provision for the welfare of the service users they take their wishes and feelings into account. 31/07/2009 The home is not currently providing enough activity both inside and outside the home. The residents best interests must be taken into account and provided for. 3 18 13 The registered person must 31/07/2009 make arrangements through staff training or other means to prevent service users being abused or placed at risk of harm or abuse. The number of staff trained in safeguarding vulnarable adults must improve. The homes procedures must always be followed when dealing with any suspicions of abuse. 4 26 13 The registered person must make arrangements to prevent infection and the spread of infection. 31/07/2009 The staff must be trained to Care Homes for Older People Page 32 of 35 prevent infection and they must have the equipment they need to prevent the spread of infection. The staff must also be supervised or monitored to ensure that they are using correct procedures and equipment. 5 32 12 The registered person must 31/07/2009 conduct the home so as to make proper provision for the health an dwelfare of the residents. The home must be managed effectively and the regulations must be met for the benefit of the residents. 6 33 24 The registered person must establish and maintain a system for reviewing and improving the quality of the care at the home. 31/07/2009 The quality audit results must be available at the home for inspection and they must demonstrate how the views of the residents have been used to make improvements to the home and the service. 7 36 18 The registered person must ensure that the staff are appropriately supervised. 31/07/2009 The records to demonstarte that staff are appropriately supervised must be available at the home. Care Homes for Older People Page 33 of 35 8 38 23 The registered person must 31/07/2009 make adequate arrangements for the maintenence of all fire equipment and for reviewing fire procdures and the testing of equipment. The fire tests must be carried out according to guidance from the fire authority and recorded. 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 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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